Association of initial management on readmissions for spontaneous pneumothorax in adolescents

In adolescents, initial treatment of spontaneous pneumothorax (PTX) must balance the recurrence risk with invasiveness. While institutional series have sought to define the role of early intervention, large-scale analysis is lacking. The present study aimed to evaluate the impact of initial strategy on recurrence and resource utilization in a nationally representative cohort.

Patients (10-20 years) admitted for first-time pneumothorax were identified using the 2010-2019 Nationwide Readmissions Database. Based on the initial management strategy, patients were classified as nonoperative management, chest tube drainage only, and operative intervention. Multivariable regression was used to evaluate the impact of approach on outcomes of interest. The primary outcome was recurrence within 90 days, while length of stay and hospitalization costs were secondarily considered.

Of an estimated 20,887 patients, 35.5% were classified as nonoperative management, 35.2% as chest tube drainage only, and 29.2% as operative intervention. Compared to others, the operative intervention cohort more frequently had Marfan syndrome and emphysematous blebs. After adjustment, patients initially managed operatively experienced lower odds of recurrence (adjusted odds ratio: 0.48, 95% confidence interval: 0.36-0.64), while chest tube drainage only had increased risk (adjusted odds ratio: 1.93, 95% confidence interval: 1.59-2.34) with nonoperative management as reference. Incremental 90-day length of stay was greater in operative intervention (β: +2.4 days, 95% confidence interval: 1.8-3.0) compared to nonoperative management, but 90-day costs were similar.

Initial operative management for first-time pneumothorax appears to reduce risk of recurrence while demonstrating similar total costs. Due to high recurrence rates associated with conservative approaches, initial surgical intervention may be considered in this patient population.