Prolonged air leakage in secondary spontaneous pneumothorax: is proportion of emphysema important?

Prolonged air leakage is the most common complication that can cause severe problems in cases of secondary spontaneous pneumothorax (SSP). The purpose of this study was to explore whether Goddard Classification Score (GCS) can be a marker of prolonged air leakage, particularly during the post-operative period, for patients with emphysema.

Fifty patients, who underwent tube thoracostomy for SSP, were retrospectively evaluated. For the evaluation of emphysematous on the preoperative computed tomography image, visual scoring system described by Goddard was used. The correlations between age, duration of hospitalization, duration of drainage, number of pneumothorax episodes, prolonged air leakage and GCS parameters, were evaluated.

When 50 patients were scored, based on GCS, the distribution was as follows: G1: four cases, G2: 16 cases, G3: 17 cases, and G4: 13 cases. The mean number of pneumothorax episodes was 1.3 ± 0.5, the mean duration of drainage was 15.7 ± 11.3 days, and the mean duration of hospitalization was 9.2 ± 5.1 days. Prolonged air leakage was seen in 26 (52.2%) cases. The rate of prolonged air leakage was significantly higher in higher GCS cases (P = 0.035). There was a positive correlation between age and GCS (P = 0.011). The number of pneumothorax episodes rose significantly with increasing GCS (P = 0.011). The duration of hospitalization increased with the growing number of pneumothorax episodes (P = 0.027).

Prolonged air leakage and the recurrence rate of SSP rise with increasing GCS. Taking this condition into consideration in the treatment algorithm can be helpful for clinicians in patient follow-up.