Factors Associated With Early Recurrence in Non-Surgically Managed Primary Spontaneous Pneumothorax

The indications for surgery in primary spontaneous pneumothorax (PSP) at first episode are clearly defined. Despite the indications, some patients avoid surgical treatment. This study examines the factors affecting early recurrence in patients who have not undergone surgical intervention.

This retrospective and multicenter study was conducted between January 2018 and June 2023. The impact of demographic characteristics, inflammatory response, smoking habits before and after the episode, treatment modality, duration of chest tube drainage, and quantitative measurements of bullae-bleb structures on the risk and timing of recurrence was examined in 117 cases of first episode PSP.

Age, sex, inflammatory response indicators, pre-episode smoking history, pneumothorax volume, and bullae size were not associated with earlier recurrence. The detection of bullae-blebs on computed tomography in first episode PSP and smoking post-episode in non-surgically treated cases were correlated with earlier recurrence (p = 0.031; p = 0.019, respectively). In cases that surgical intervention had not been performed, a prolonged duration of chest tube drainage correlated with increased recurrence-free survival and decreased recurrence risk (p = 0.002).

In cases of first episode PSP, surgical intervention may be advised when bullae-bleb formations are detected via tomography. Patients who did not undergo surgical treatment during the first episode and smoke after discharge are at higher risk of earlier recurrence. Prolonged chest tube drainage duration reduces the risk of earlier recurrence in first-episode PSP cases that have not undergone surgical intervention. This finding suggests that extended drainage is not a disadvantageous outcome for cases hesitant to undergo surgical treatment.