Early Operative Intervention in Primary Spontaneous Pneumothorax for Active-Duty Service Members

Primary spontaneous pneumothorax (PSP) is a common benign thoracic condition that is often managed conservatively in civilian (CIV) health care. Conversely, it is managed operatively in the military (MIL). We examined the differences between PSP management between MIL and CIV health care facilities to elucidate differences in operative and conservative management.

We conducted a retrospective review of all admissions for PSP within the Department of Defense insurance claims database from 2015 to 2022 and compared MIL and CIV practices.

CIV management was associated with a longer median length of stay in days (3.0 [interquartile range (IQR 3)] versus 4.0 [IQR 4], P = 0.045). Recurrence after nonoperative management was associated with a significantly longer median length of stay at 8 days (IQR 5) versus 5 days (IQR 4, P < 0.001); however, costs remained similar ($43,423 [IQR $41,281], operative versus $50,172 [IQR $41,636], nonoperative, P = 0.298).

Current guidelines advocate for initial nonoperative management. Initial operative management is associated with a lower length of stay with low rates of recurrence. This data add to the growing body of literature advocating for initial operative management of PSP in select patients and current guidelines should be updated.