Udelsman Brooks V, Chang David C, Lanuti Michael, Mathisen Douglas J, Muniappan Ashok
Department of General Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
Department of General Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA.
Am J Surg. 2022 Feb;223(2):404-409. doi: 10.1016/j.amjsurg.2021.05.017. Epub 2021 Jun 10.
We sought to determine the rate and risk factors of recurrent spontaneous pneumothorax in a diverse population.
Cohort study using the California Public Discharge Data file (1995-2010). We identified patients with first-time spontaneous pneumothorax. The primary outcome was recurrent pneumothorax. Associations with clinical, patient, and hospital characteristics were assessed using Cox regression analysis.
Among 14,609 patients with a first-time episode of spontaneous pneumothorax, 26.2% developed a recurrence. Risk factors included age <35 (Hazard Ratio [HR] 1.24 95%-Confidence Interval [CI] 1.14-1.36), Asian race (HR 1.24, CI 1.13-1.37), and tube thoracostomy (HR 1.2, CI 1.15-1.31). Mechancial pleurodesis (HR 0.37 CI 0.31-0.45) was superior to chemical pleurodesis (HR 0.71 CI 0.58-0.86) in reducing recurrence risk.
The risk of recurrent pneumothorax is greatest in patients age <35, Asians, and those requiring a tube thoracostomy. The risks of operative intervention should be balanced against patient risk for recurrence.
我们试图确定不同人群中复发性自发性气胸的发生率及危险因素。
采用加利福尼亚公共出院数据文件（1995 - 2010年）进行队列研究。我们确定了首次发生自发性气胸的患者。主要结局是复发性气胸。使用Cox回归分析评估与临床、患者及医院特征的相关性。
在14,609例首次发生自发性气胸的患者中，26.2%出现复发。危险因素包括年龄<35岁（风险比[HR] 1.24，95%置信区间[CI] 1.14 - 1.36）、亚洲人种（HR 1.24，CI 1.13 - 1.37）以及胸腔闭式引流术（HR 1.2，CI 1.15 - 1.31）。在降低复发风险方面，机械性胸膜固定术（HR 0.37，CI 0.31 - 0.45）优于化学性胸膜固定术（HR 0.71，CI 0.58 - 0.86）。
年龄<35岁的患者、亚洲人以及需要进行胸腔闭式引流术的患者复发性气胸风险最高。手术干预的风险应与患者的复发风险相权衡。
