When Is the Optimal Timing of the Surgical Treatment for Secondary Spontaneous Pneumothorax?

Abstract

The definition of spontaneous pneumothorax is accumulation of air in the pleural space, resulting in dyspnea or chest pain. Unlike primary spontaneous pneumothorax, secondary pneumothorax can be a life-threatening condition and spontaneous healing rate is uncommon. Although surgery is the most effective treatment modality for pneumothorax, surgical management and timing is difficult where there is underlying lung disease and/or medical comorbidities. Prolonged air leakage increases the morbidity and mortality in thoracic surgery. We hypothesized that duration of air leakage before operation may lead to increase in complications. This study is a retrospective review of 155 consecutive patients with air leakage who underwent bullectomy for secondary spontaneous pneumothorax from January 2005 to July 2013. The patients were divided according to the duration of preoperative air leakage. The patients were followed-up until the time of last visit or death. Postoperative morbidity and mortality were assessed and the risk factors for complications were analyzed. The median age was 65 years (range, 52-88) with male predominance (96.13%). The median duration of preoperative air leakage was 6 days (range, 1-30). The median surgery time was 90 minutes (range, 25-300) and median hospital stay after operation was 7 days (range, 3-75). Postoperative complications occurred in 38 patients (24.52%) and postoperative recurrence was shown to have occurred in 8 patients (5.16%). With multivariate analysis, risk factors for postoperative complications were: underlying interstitial lung disease and air leakage > 5 days before operation. Persistent air leakage was a major surgical indication for pneumothorax. Early surgical treatment reduced postoperative complications for secondary spontaneous pneumothorax.

Influence of old pulmonary tuberculosis on the management of secondary spontaneous pneumothorax in patients over the age of 70 years

“…Therefore, in recent years, age alone has not been used as a criterion for any type of surgery for SSP. Several studies have shown favorable outcomes by applying the surgical principle of minimal repair in elderly patients with SSP (20,21,23,24). Surgeries following this principle aim to excise only the targeted, active leakage point, and avoid performing a bullectomy of thick-walled bullae or a lung-volume-reduction surgery.…”

Outpatient Treatment of Pneumothorax with a Thoracic Vent: Economic Benefit

“…It has been reported that if an air leak persists for >48 h, continued chest tube suction for up to a total of 10 days yielded few additional pleural closures in patients with primary or secondary spontaneous pneumothorax [24]. Furthermore, air leakage for >5 days before surgery was described as a risk factor for postoperative complications [25]. …”

Should we wait for the bubble to explode?

“…The optimal timing of surgery is not controversial in young patients with primary spontaneous pneumothorax (PSP) if air leakage persists (4,5). However, the optimal timing of surgery is difficult to determine in cases of secondary spontaneous pneumothorax (SSP) with persistent air leakage (6).…”

“…Furthermore, the spontaneous healing rate of air leakage is lower and the recurrence rate is significantly higher in patients with SSP than in those with PSP (11,12). Postoperative morbidity has been reported to be 20.6-25.2% (6,(13)(14)(15), and the postoperative mortality rate was found to be approximately 5% in patients with SSP (13,14).…”

“…Thus, they recommend surgery for patients with air leakage persisting beyond 14 days (11). However, several investigators have recommended surgery as early as 3 days for persistent air leakage because delayed surgery is associated with a higher rate of pleural infection, and the healing rate is lower in patients with SSP than in those with PSP (6,16,17). The mortality rate of pleural infection is up to 20% (16).…”