Primary Spontaneous Pneumothorax Outcomes in Children: A National Analysis
Carlos Theodore Huerta1, Rebecca A Saberi1, Gareth P Gilna1
1University of Miami Miller School of Medicine, FL, USA.
Insights
Pediatric primary spontaneous pneumothorax (PSP) nonoperative management (NOM) leads to higher readmission and recurrence rates compared to surgery. Socioeconomic status influences treatment choices for PSP in children.
Area of Science:
- Pediatric Thoracic Surgery
- Pulmonary Medicine
- Health Services Research
Background:
- Primary spontaneous pneumothorax (PSP) management in children lacks standardized protocols, leading to outcome variations.
- Understanding nationwide outcomes is crucial for optimizing pediatric PSP care.
Purpose of the Study:
- To compare national outcomes of pediatric patients diagnosed with primary spontaneous pneumothorax (PSP).
- To evaluate the effectiveness of nonoperative management (NOM) versus operative resection for pediatric PSP.
Main Methods:
- Utilized the Nationwide Readmissions Database (2016-2018) for patients aged 1-18 with PSP.
- Excluded trauma, secondary pneumothoraces, and elective admissions.
- Compared demographics and complications between initial NOM (observation/percutaneous drainage) and operative resection groups.
Main Results:
- 3,890 pediatric PSP patients identified; 78% received initial NOM.
- NOM failure rate was 17%, with 28% overall failure during index admission or readmission.
- NOM group showed significantly higher 30-day and overall readmission rates (P < 0.001).
- Ipsilateral recurrence was higher in NOM (13%) vs. operative (3%) groups (P < 0.001).
- Lower socioeconomic status patients received NOM more often and had more readmissions.
Conclusions:
- Initial nonoperative management for pediatric PSP is associated with increased readmission and recurrence rates.
- Operative resection demonstrates superior outcomes regarding readmission and recurrence.
- Socioeconomic factors significantly impact the choice between nonoperative and operative management for pediatric PSP.
Objective:
Considerable variation in primary spontaneous pneumothorax (PSP) management exists in the pediatric population. This study aims to compare nationwide outcomes of children with PSP.
Methods:
The Nationwide Readmissions Database (2016 to 2018) was used to identify patients 1 to 18 years old with PSP. Trauma, secondary pneumothoraces, and elective admissions were excluded. Demographics and complications were compared among patients undergoing initial nonoperative management (NOM; observation or percutaneous drainage) or operative resection using standard statistical tests.
Results:
A total of 3,890 patients were identified with PSP (median age, 16 [interquartile range 14 to 17] years). Most (78%) underwent NOM, of which 17% failed requiring operative resection. Of the intent-to-treat cohort, 28% failed NOM during index admission or required repeat percutaneous drainage or operative resection on readmission. Patients treated by NOM had higher 30-day and overall readmission rates compared with operative resection (all P < 0.001). Ipsilateral recurrent pneumothorax was higher in those receiving NOM (13% vs 3%, P < 0.001). Patients from the lowest median household income quartile more frequently received NOM compared with the highest income quartile (82% vs 76%) with more readmissions.
Conclusions:
Patients with PSP who underwent initial NOM experienced higher readmission rates than those receiving operative resection. Furthermore, socioeconomic status was associated with the utilization of nonoperative versus operative management.
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