Children with large primary spontaneous pneumothoraxes may benefit from early operative intervention

Primary Spontaneous Pneumothorax Outcomes in Children: A National Analysis

“…8,11 Despite the reduced morbidity and risks associated with NOM compared with operative resection, several studies have demonstrated that at least one-third of patients treated by this strategy require surgical resection during the same admission. 8,11,14 The failure rate of NOM in our study was somewhat lower than the rates of 33% to 57% reported previously. [10][11][12][13][14] Given that this study followed readmissions and recurrence for 1 year, it is possible that longer term follow-up may uncover higher disease recurrence rates as in other studies.…”

“…8,11,14 The failure rate of NOM in our study was somewhat lower than the rates of 33% to 57% reported previously. [10][11][12][13][14] Given that this study followed readmissions and recurrence for 1 year, it is possible that longer term follow-up may uncover higher disease recurrence rates as in other studies. 18 Other studies comparing PSP management have found operative resection in the same admission to result in shorter hospitalizations and fewer recurrences compared with NOM.…”

“…For example, there are no ICD codes to report individual sizes of pneumothoraces or if pleurodesis was performed via tube thoracostomy without operative intervention and previous studies have found that patients with larger pneumothoraces greater than 2 cm are significantly more likely to fail NOM and require surgical intervention. 14 The extent of pulmonary blebs or multiple previous episodes of PSP may influence the choice for initial operative resection, which could not be delineated in this data set. In addition, there is no information on vital signs or oxygenation status on initial presentation from this database, which may necessitate immediate tube thoracostomy or other percutaneous catheter placement and preclude noninvasive observation strategies.…”

“…[7][8][9][10] Although PSP can be managed effectively without surgery, concern for recurrent episodes exists, with some studies estimating a failure rate of 33% to 57% of initial nonoperative management (NOM). [10][11][12][13][14] Conversely, surgical management including pulmonary wedge resection, often via video-assisted thoracoscopic surgery (VATS), is associated with shorter length of stay in some series and a lower risk of recurrence compared with initial NOM. 10 However, VATS incurs the risks and morbidity associated with thoracic surgical intervention.…”