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Could the probability of surgical indication be determined after first episode of primary spontaneous pneumothorax?

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General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objectives

To develop a risk score model for primary spontaneous pneumothorax surgery (prolonged air leak or ipsilateral recurrence). The model was internally validated for risk estimation.

Methods

We analyzed 453 patients with primary spontaneous pneumothorax between 2014 and 2018. Patients were randomly assigned a 2:1 ratio to the development dataset (n = 302, study cohort) or the internal validation dataset (n = 151, validation cohort). The final outcomes of patients with primary spontaneous pneumothorax, the presence or absence of surgical indications, were tracked. Multivariable logistic regression models were prepared to estimate the probability of surgical indication and a scoring model was created. It was internally validated using the validation cohort. Calibration was ascertained using the Hosmer–Lemeshow method and Brier score.

Results

The surgery indication rate was 47.8% (n = 217) (prolonged air leak, n = 130; ipsilateral recurrence, n = 87). There were no demographic or radiological differences between the validation and the study cohorts. Logistic regression analysis showed that the presence of bullae or blebs (p < 0.001, odds ratio = 3.340, 95%CI = 1.753–6.363) and pneumothorax volume (p < 0.001, odds ratio = 1.033, 95%CI = 1.019–1.048) were independent risk factors for surgical indication. The scoring model significantly predicted surgical indications (area under the curve, AUC = 0.768, 95%CI = 0.714–0.821, p < 0.001). Our model showed acceptable discrimination with an AUC > 0.75 in the validation set (AUC = 0.777, 95%CI = 0.702–0.852, p < 0.001) and had an adequate calibration (Hosmer–Lemeshow test p = 0.249, Brier score = 0.25).

Conclusion

The internally validated primary spontaneous pneumothorax scoring model was a good predictor of the need for surgery in patients with primary spontaneous pneumothorax. Prospective external validation studies with larger patient cohorts are required.

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Data availability

The authors have full control of all primary data and that we agree to allow the journal to review their data if requested. The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. However, the data will be shared on reasonable request to the corresponding author.

Abbreviations

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

DSS:

Dystrophic severity score

Log odds:

Logarithm of the odds

NPV:

Negative predictive value

PPV:

Positive predictive value

PSP:

Primary spontaneous pneumothorax

PAL:

Prolonged air leak

ROC:

Receiver operating curve

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Acknowledgements

We would like to thank Editage ® (www.editage.com) for English language editing.

Funding

The authors received no financial support for the research and/or authorship of this study.

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Authors and Affiliations

  1. Thoracic Surgery Department, Bakirköy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey

    Necati Çıtak, Servet Özdemir & Selçuk Köse

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  1. Necati Çıtak
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  2. Servet Özdemir
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  3. Selçuk Köse
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Contributions

NÇ: formal analysis; investigation; software; writing—original draft; conceptualization; methodology; resources; validation; visualization; writing—review and editing; supervision; and project administration. SÖ: data curation; investigation; writing—original draft; resources; visualization; writing—review, and editing. SK: investigation, software, validation, and supervision.

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Correspondence to Necati Çıtak.

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Çıtak, N., Özdemir, S. & Köse, S. Could the probability of surgical indication be determined after first episode of primary spontaneous pneumothorax?. Gen Thorac Cardiovasc Surg 71, 472–479 (2023). https://doi.org/10.1007/s11748-023-01913-y

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