Population-based study on surgical care for primary spontaneous pneumothorax

Area of Science:

• Thoracic Surgery
• Pulmonology
• Health Services Research

Background:

• Surgical strategies for primary spontaneous pneumothorax (PSP) lack standardization, leading to practice variations.
• These variations can impact patient outcomes, including postoperative complications and hospital length of stay.
• Understanding current practice patterns is crucial for improving PSP management.

Purpose of the Study:

• To analyze national surgical practice patterns for PSP in the Netherlands.
• To quantify the variability in surgical interventions and associated outcomes across hospitals.
• To identify areas for potential optimization in PSP surgical care.

Main Methods:

• A national population-based registry study using the Dutch Lung Cancer Audit-Surgery database (2014-2021).
• Inclusion of patients who underwent surgical pleurodesis and/or bullectomy for PSP.
• Data collection on surgical procedure type, postoperative complications, length of stay, and recurrence rates.

Main Results:

• 1851 PSP patients identified; median age 25 years, 82% male.
• Bullectomy with pleurodesis was the most common procedure (83%).
• Overall complication rate was 12% (6% Clavien-Dindo grade ≥III), with persistent air leak >5 days being most common (5%). Median postoperative stay was 4 days.
• Significant between-hospital variability in complication rates and length of stay was observed.
• No significant outcome differences were found between distinct surgical procedures.

Conclusions:

• Bullectomy with pleurodesis is the preferred surgical approach for PSP in the Netherlands.
• Considerable variation exists in postoperative complications and length of stay among Dutch hospitals for PSP patients.
• Optimization of surgical care pathways is recommended to reduce variability and improve outcomes in this patient population.