Predictive factors for prolonged hospitalization related to pneumothorax after CT-guided transthoracic needle biopsy

Pneumothorax is consistently reported as the most prevalent complication of computed tomography-guided transthoracic needle biopsy. While most cases of pneumothorax resolve with conservative management strategies, some cases are linked to a more protracted clinical trajectory necessitating active intervention. However, few reports have described the clinical and procedural determinants of prolonged hospitalization after post-biopsy pneumothorax.

This retrospective study analyzed 1,457 CT-guided TTNB procedures performed at a tertiary referral center between January 2021 and December 2025. The incidence of post-biopsy pneumothorax was 20.5%. Among 82 patients with prolonged hospitalization due to pneumothorax, their management strategies were categorized into two groups: (1) high-concentration oxygen therapy (n = 54) and (2) invasive interventions, including percutaneous catheter drainage (PCD) or chest tube insertion (n = 28). Logistic regression models with backward selection were used to identify predictive factors for prolonged hospitalization.

Among the 82 patients with prolonged hospitalization due to pneumothorax, the median age was 75 years and 75.6% were male. In multivariable analysis, a lower diffusing capacity for carbon monoxide (DL_CO) was independently associated with prolonged hospitalization (adjusted odds ratio [aOR], 0.980; P = 0.004). In the high-concentration oxygen group, lower DL_CO (aOR, 0.974; P = 0.007) and a trans-fissural needle route (aOR, 3.968; P = 0.028) were independently associated with prolonged hospitalization. Conversely, in the PCD/chest tube group, reduced forced expiratory volume in 1 s was independently associated with prolonged hospitalization (aOR, 0.961; P = 0.002).

In patients with post-biopsy pneumothorax, impaired pulmonary function may be linked to a prolonged clinical course. Incorporating these pre-procedural physiological markers may facilitate improved risk stratification and optimized hospital resource allocation.