Spontaneous pneumothorax: determinants of surgical intervention.

OBJECTIVE

To assess the long term efficacy of intercostal tube drainage for spontaneous pneumothorax and determine the clinical parameters associated with surgery.

EXPERIMENTAL DESIGN

Retrospective analysis with a mean follow-up of 62.3+/-19.3 months (range 23 to 94 months).

SETTING

Riyadh Medical Complex, Riyadh (Saudi Arabia), the biggest referral centres for Ministry of Health providing specialized hospital care.

PATIENTS

Over a period of six year, 123 patients had 182 episodes of spontaneous pneumothorax. Male to female ratio was 29.75:1 (p=0.00001). Average age was 26.35+/-8.33 years for men and 37.25+/-14.6 years for women (p=0.01). Seventy eight per cent of patients were aged 11 to 30 years (p=0.00001). Majority were nonsmokers (100/123, p=0.00001). It was first episode of spontaneous pneumothorax for 86 patients. Other 37 patients had 57 episodes previously (mean 1.54+/-0.73; range 1 to 4).

INTERVENTIONS

Intercostal tube drainage for all patient with spontaneous pneumothorax. Limited axillary thoracotomy with bullectomy and pleuroabrasion for 32 patients not responding to intercostal tube drainage.

RESULTS

Intercostal tube drainage alone had success rate of 90.7% in first, 52.4% in second, 15.4% in third and 0% for more than 3 episodes of spontaneous pneumothorax. Among the 32 patients who underwent surgery, only one had early recurrence that did not require drainage. We found that patients with history of recurrence, respiratory distress and those requiring tube thoracostomy for more than 4 days and negative suction to expand the lung were more liable to undergo surgical intervention (p=0.00001 for all variables).

CONCLUSIONS

We recommend early surgery to hasten recovery and shorten the hospital stay in patients with history of recurrent spontaneous pneumothorax, respiratory distress and those requiring tube thoracostomy for more than 4 days and negative suction to expand the lung.