Fung Stephen, Alexander Andrea, Ashmawy Hany, Dizdar Levent, Safi Sami, Rehders Alexander, Fluegen Georg, Knoefel Wolfram Trudo
Department of Surgery, University Hospital Duesseldorf and Heinrich-Heine-University Duesseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
Healthcare (Basel). 2021 Sep 19;9(9):1236. doi: 10.3390/healthcare9091236.
Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. The socioeconomic impact of recurrent PSP on the healthcare system is insufficiently reported.
Ninety-six patients treated for PSP between 01/2010 and 01/2020 were included. Forty-eight patients underwent primary VATS, while the second group received chest tube (CT) treatment only. Length of hospital stay (LOS), duration of chest tube, prolonged air leak, postoperative complications, recurrences and treatment costs were analyzed.
Prolonged air leaks were evident in 12.5% and 22.9% patients of the VATS and CT group, respectively. Ten (20.8%) patients in the CT group underwent VATS for persistent air leakage. During follow-up, the VATS group recurred at 8.3% compared to 52.1% in the CT group. The total cost of treatment per patient, including treatment cost due to recurrence, was EUR 1.501 in the VATS group and EUR 2.233 in the CT group.
Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP.
当前指南推荐采用电视辅助胸腔镜手术（VATS）治疗复发性原发性自发性气胸（PSP）以及胸腔闭式引流治疗后持续漏气的病例。复发性PSP对医疗系统的社会经济影响报道不足。
纳入2010年1月至2020年1月期间接受PSP治疗的96例患者。48例患者接受了初次VATS手术，而第二组仅接受了胸腔闭式引流（CT）治疗。分析了住院时间（LOS）、胸腔闭式引流持续时间、持续漏气、术后并发症、复发情况和治疗费用。
VATS组和CT组分别有12.5%和22.9%的患者出现持续漏气。CT组中有10例（20.8%）患者因持续漏气接受了VATS手术。在随访期间，VATS组的复发率为8.3%，而CT组为52.1%。VATS组每位患者的总治疗费用（包括复发后的治疗费用）为1501欧元，CT组为2233欧元。
由于复发率高，PSP的CT初始治疗会给患者和医疗系统带来增加的社会经济负担。如果在PSP的首发时考虑采用VATS，这种负担可能会减轻。
