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[Treatment of spontaneous pneumothorax. Immediate results and cumulative frequency of recurrence]
H L Lippert1, O Lund, S Blegvad
1Hjerte-lunge-Karkirurgisk Afdeling, Skejby Sygehus, Arhus.
Abstract:
From 1975 through 1987, 142 patients were treated for their first spontaneous pneumothorax. A total of 745 patient-years (mean 5.2 years, maximum 12.8 years) had been accumulated by June 1988. A total of 32 radiographically verified recurrences were recorded; 72% occurred within the first two years after treatment. The one-, five-, and ten-year cumulative freedoms from recurrence +/- standard error were 88 +/- 3%, 75 +/- 4% and 69 +/- 5%, respectively. The elective duration of tubulation was shortened from 10 to four days; this did not result in a higher complication rate; rather, there was a tendency to a reduced recurrence rate. Placement of the suction tube in 4th-5th intercostal space in anterior axillary line gave a significant greater recurrence rate than placement in 2nd-3rd intercostal space in midclavicular line. Also advanced age, female gender, non-smoking (patients who had never smoked), non-tobaccoabstinence (smokers who did not stop smoking), chronic obstructive lung disease, radiographic emphysema/fibrosis/bullae/blebs and a high height/weight ratio increased the cumulative recurrence rate. The tendency to recurrence after spontaneous pneumothorax showed a characteristic time-related pattern and should be analyzed using an appropriate time-related statistical method. Shortening of elective duration of tubulation may be accomplished without increased complication rate and possibly with a reduction of the cumulative recurrence rate.
Insights
Recurrence after spontaneous pneumothorax is common, especially within two years. Shortening chest tube treatment duration and optimizing tube placement can reduce recurrence rates without increasing complications.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
Context:
- Spontaneous pneumothorax (SP) is a significant clinical concern with a high recurrence rate.
- Understanding factors influencing SP recurrence is crucial for effective patient management and treatment optimization.
Purpose:
- To analyze recurrence patterns and identify risk factors for spontaneous pneumothorax.
- To evaluate the impact of treatment modifications, including chest tube duration and placement, on recurrence rates.
Summary:
- A 13-year study of 142 patients treated for first spontaneous pneumothorax revealed a 1-, 5-, and 10-year recurrence-free survival of 88%, 75%, and 69%, respectively.
- Recurrences predominantly occurred within the first two years.
- Shortening chest tube duration from 10 to 4 days did not increase complications and showed a trend towards reduced recurrence. Anterior axillary tube placement was associated with higher recurrence than midclavicular placement.
- Risk factors for recurrence included advanced age, female gender, never smoking, not abstaining from smoking, COPD, radiographic emphysema/fibrosis/bullae/blebs, and a high height/weight ratio.
Impact:
- Findings suggest that optimizing chest tube management, specifically duration and placement, can mitigate spontaneous pneumothorax recurrence.
- Identification of patient-specific risk factors allows for personalized risk assessment and potentially tailored preventative strategies.