Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis

Abstract

Primary spontaneous pneumothorax (PSP) recurrence rates vary widely in the published literature, with limited data describing the factors that influence recurrence. The aims of this systematic review were to determine an estimation of PSP recurrence rates and describe risk factors for recurrence.A systematic review was conducted of all studies reporting PSP recurrence. Electronic searches were performed to identify English language publications of randomised trials and observational studies. The population was adults with PSP, who underwent conservative management, pleural aspiration or chest drainage. The outcome of interest was recurrence. Articles were screened and data extracted from eligible studies by two reviewers.Of 3607 identified studies, 29 were eligible for inclusion, comprising 13 548 patients. Pooled 1-year and overall recurrence rates were 29.0% (95% CI 20.9-37.0%) and 32.1% (95% CI 27.0-37.2%), respectively. Female sex was associated with increased recurrence (OR 3.03, 95% CI 1.24-7.41), while smoking cessation was associated with a four-fold decrease in risk (OR 0.26, 95% CI 0.10-0.63). for random effects meta-analysis was 94% (p<0.0001), reflecting high heterogeneity between studies.This systematic review demonstrates a 32% PSP recurrence rate, with greatest risk in the first year. Female sex was associated with higher risk, suggesting possible sex-specific pathophysiology.

Does the Chest Tube Removal Time Influence the Outcomes of Primary Spontaneus Pneumothorax First Episode Management?

“…How to prevent recurrence of PSP without surgery is unclear. There is a hypothesis that chest tube may irritate the pleural surface and may work like mechanical pleurodesis [14,30,31]. This probably could explain findings in some studies which showed that the recurrence rate after conservative management (without any intervention or only needle aspiration) is higher comparing to chest tube drainage [14,21,22,27].…”

“…The recent large systematic review and meta-analysis on PSP recurrence after nonsurgical management (conservative management, needle aspiration, chest tube drainage) showed that the estimated recurrence rate was 32% and varied from 8% up to 74% [30]. The risk of PSP recurrence after chest tube drainage is up to 42% [6].…”

“…Rezultatai. Vidutinis pacientų amžius -27 (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) metai. 78 proc.…”

Digital versus analogue chest drainage system in patients with primary spontaneous pneumothorax: a randomized controlled trial

“…The management of PSP is based on two principles: first, the initial management of the pneumothorax with symptom control and re-expansion of the lung and secondly, reducing recurrence rate [4]. The recurrence rate is reported to be between 17 and 54% [5][6], with the majority of recurrences in the first year after the primary event [7]. Recurrence rate can be reduced by surgical pleurectomy or thoracoscopic pleurodesis [8].…”

“…Recurrence rate can be reduced by surgical pleurectomy or thoracoscopic pleurodesis [8]. Initial management of PSP has been subject of ongoing debate [4,8], with a trend towards a more conservative approach using manual aspiration and outpatient treatment [4,6,[8][9][10][11][12]. Manual aspiration has been shown to be effective in approximately two-thirds of patients [8] and is as equally effective as chest tube drainage [8].…”