European Pediatric Surgeons' Association Survey on the Management of Primary Spontaneous Pneumothorax in Children
Tutku Soyer1, Anne Dariel2, Jens Dingemann3
1Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Insights
Pediatric surgeons often use chest tubes for initial primary spontaneous pneumothorax (PSP) but opt for surgery in recurrent cases or large bullae. Thoracoscopic surgery leads to better outcomes and shorter chest tube use.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Pulmonology
Background:
- Primary spontaneous pneumothorax (PSP) in children requires standardized management strategies.
- Current practice patterns among European pediatric surgeons for PSP are not well-defined.
Purpose of the Study:
- To investigate the current practice patterns of European Pediatric Surgeons' Association (EUPSA) members in managing pediatric PSP.
- To identify variations in treatment approaches for initial and recurrent PSP episodes.
Main Methods:
- An online survey was distributed to EUPSA members across 44 countries.
- 131 members participated, providing data on their management preferences for PSP.
Main Results:
- Interventional management, primarily chest tube insertion (71%), is favored for the first PSP episode (78%).
- Surgical intervention (49%) is preferred for the second episode, especially with bullae >2cm (77%) or recurrence (76%).
- Thoracoscopy is preferred (84%) over open surgery, with associated trends towards more surgical pleurodesis and shorter chest tube duration.
Conclusions:
- Chest tube insertion is common for first PSP episodes, while surgery is reserved for subsequent events or specific indications.
- Thoracoscopic approaches are associated with improved outcomes and reduced chest tube duration compared to open surgery.
- Evidence-based guidelines are needed to standardize pediatric PSP management and enhance patient outcomes.
Aim:
To evaluate the practice patterns of the European Pediatric Surgeons' Association (EUPSA) members regarding the management of primary spontaneous pneumothorax (PSP) in children.
Methods:
An online survey was distributed to all members of EUPSA.
Results:
In total, 131 members from 44 countries participated in the survey. Interventional approach (78%) is the most common choice of treatment in the first episode, and most commonly, chest tube insertion (71%) is performed. In the case of a respiratory stable patient, 60% of the responders insert chest tubes if the pneumothorax is more than 2 cm. While 49% of surgeons prefer surgical intervention in the second episode, 42% still prefer chest tube insertion. Main indications for surgical treatment were the presence of bullae more than 2 cm (77%), and recurrent pneumothorax (76%). Eighty-four percent of surgeons prefer thoracoscopy and perform excision of bullae with safe margins (91%). To prevent recurrences, 54% of surgeons perform surgical pleurodesis with pleural abrasion (55%) and partial pleurectomy (22%). The responders who perform thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the surgeons performing open surgery (p < 0.05).
Conclusion:
Most of the responders prefer chest tube insertion in the management of first episode of PSP and perform surgical treatment in the second episode in case of underlying bullae more than 2 cm and recurrent pneumothorax. The surgeons performing thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the responders performing open surgery. The development of evidence-based guidelines may help standardize care and improve outcomes in children with PSP.
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