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Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis

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Abstract

Purpose

To compare the effectiveness and safety between needle aspiration (NA) and closed thoracostomy (CT) method in adult spontaneous pneumothorax (SP) patients and to explore the most effective and safe protocol by using meta-analysis method.

Materials and Methods

This study was based on Cochrane methodology for conducting meta-analysis. Only randomized controlled trials were eligible for this study. The participants were adults who had SP. The Review Manager Database was used to analyze selected studies.

Results

Nine RCTs involving 665 patients were included. Although the initial success rate of CT was higher, the two groups were not statistically significant (RR 0.87 [95% CI 0.76–1.00]; p = 0.05). Compared the NA group, the use of CT method to treat SP significantly increased complications (RR 0.17 [95% CI 0.06–0.45]; p = 0.0003) and operation rate (RR 0.57 [95% CI 0.35–0.95]; p = 0.03). There was no significant difference in the 1-week success rate, admitted rate, 3-month recurrence rate, 1-year recurrence rate, and recurrence time between the two groups. Subgroup analysis of primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) patients showed that the initial success rate of the CT method was higher than NA group (RR 0.74 [95% CI 0.60–0.92]; p = 0.007).

Conclusions

For the treatment of SP, NA method could significantly decrease complication rate, operation rate, as well as hospital stay length, compared with the CT method. Subgroup analysis indicated that the use of CT method in SSP and PSP patients might increase the initial success rate.

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Authors and Affiliations

  1. Department of Emergency & Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Jixiang Tan & Lin Zhao

  2. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Hong Chen

  3. Department of Nephrology, Chonggang General Hospital, Chongqing, China

    Jin He

Authors
  1. Jixiang Tan
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  2. Hong Chen
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  3. Jin He
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  4. Lin Zhao
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Contributions

Conceived and designed the study: JT, LZ; Selected references and extracted data: JT, HC; Analyzed and interpreted the data: JT, HC; Wrote the paper: JT; Provided critical revisions: JH, LZ; Approved the final version of the manuscript: JT, HC, JH, LZ.

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Correspondence to Lin Zhao.

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Tan, J., Chen, H., He, J. et al. Needle Aspiration Versus Closed Thoracostomy in the Treatment of Spontaneous Pneumothorax: A Meta-analysis. Lung 198, 333–344 (2020). https://doi.org/10.1007/s00408-020-00322-9

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  • DOI: https://doi.org/10.1007/s00408-020-00322-9

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