Trends in the Management of Spontaneous Pneumothorax: A Single Center Experience

Management of patients with primary spontaneous pneumothorax is controversial. We sought to review our experience in the treatment of primary spontaneous pneumothorax (PSP) by comparing outcomes from video-assisted thoracoscopic surgery (VATS) with thoracotomy.

A retrospective review of electronic and paper medical charts identified 104 consecutive operations performed at University of Kentucky Chandler Medical Center for spontaneous pneumothorax management between the dates of January 2000 and January 2013. Follow-up phone calls were made to ensure absence of re-ocurrences outside of our hospital system.

Eighty-eight patients (85%) underwent VATS repair with unilateral and contralateral recurrence rates of 7% and 11% respectively. Mean operative time was 97 minutes; mean postoperative hospital stay was 6 days. Mechanical pleurodesis/pleurectomy was performed in 94% of cases. Comparatively 16 patients (16%) underwent thoracotomy repair with unilateral and contralateral recurrence rates of 0.00% and 6% respectively. Mean operative time for the thoracotomy group was 188 minutes; mean postoperative hospital stay was 5 days. Mechanical pleurodesis was performed 12 times (75%).

In our study, the VATS group had a significant reduction in operating room time (P = .001), a non-significant increase in unilateral recurrence (p = .587), and no reduction in postoperative length of stay. Contralateral recurrence rate did not vary between groups.