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The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax

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Abstract

Purpose

Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization.

Methods

We retrospectively examined 61 patients with SSP, and evaluated the patients’ characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization.

Results

There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38–21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44–31.06).

Conclusions

Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.

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References

  1. The Japanese Respiratory Society. The fourth edition of the guidelines for diagnosis and treatment of COPD (Chronic obstructive pulmonary disease) (in Japanese). Medical Review Co. Ltd: Tokyo; 2013.

  2. The Japanese Respiratory Society. Idiopathic Interstitial Pneumonias: Diagnosis and Treatment, 3rd Edition (in Japanese). NANKODO Co. Ltd: Tokyo; 2016.

  3. The Japanese Respiratory Society. Japanese Guideline for the Treatment of Idiopathic Pulmonary Fibrosis 2017 (in Japanese). NANKODO Co. Ltd: Tokyo; 2017.

  4. Goddard PR, Nicholson EM, Laszlo G, Watt I. Computed tomography in pulmonary emphysema. Clin Radiol. 1982;33:379–87.

    Article  CAS  PubMed  Google Scholar 

  5. Kadowaki T, Hamada H, Miyoshi S, Hamaguchi N, Sakai K, Ito R, et al. Refractory pneumothorax secondary to lung cancer in a patient with idiopathic pulmonary fibrosis. Intern Med. 2008;47:1251–4.

    Article  PubMed  Google Scholar 

  6. Shaikhrezai K, Thompson AI, Parkin C, Stamenkovic S, Walker WS. Video-assisted thoracoscopic surgery management of spontaneous pneumothorax—long-term results. Eur J Cardiothorac Surg. 2011;40:120–3.

    Article  PubMed  Google Scholar 

  7. Igai H, Kamiyoshihara M, Ibe T, Kawatani N, Shimizu K. Surgical treatment for elderly patients with secondary spontaneous pneumothorax. Gen Thorac Cardiovasc Surg. 2016;64:267–72.

    Article  PubMed  Google Scholar 

  8. Uramoto H, Tanaka F. What is an appropriate material to use with a covering technique to prevent the recurrence of spontaneous pneumothorax? J Cardiothorac Surg. 2014;9:74.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sayar A, Kök A, Citak N, Metin M, Büyükkale S, Gürses A. Size of pneumothorax can be a new indication for surgical treatment in primary spontaneous pneumothorax: a prospective study. Ann Thorac Cardiovasc Surg. 2014;20:192–7.

    Article  PubMed  Google Scholar 

  10. Al-Mourgi M, Alshehri F. Video-assisted thoracoscopic surgery for the treatment of first-time spontaneous pneumothorax versus conservative treatment. Int J Health Sci (Qassim). 2015;9:428–32.

    PubMed Central  Google Scholar 

  11. Jeon HW, Kim YD, Kye YK, Kim KS. Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy. J Thorac Dis. 2016;8:93–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Evman S, Alpay L, Metin S, Kıral H, Demir M, Yalçinsoy M, et al. The efficacy and economical benefits of blood patch pleurodesis in secondary spontaneous pneumothorax patients. Kardiochir Torakochirurgia Pol. 2016;13:21–5.

    PubMed  PubMed Central  Google Scholar 

  13. Aihara K, Handa T, Nagai S, Tanizawa K, Watanabe K, Harada Y, et al. Efficacy of blood-patch pleurodesis for secondary spontaneous pneumothorax in interstitial lung disease. Intern Med. 2011;50:1157–62.

    Article  PubMed  Google Scholar 

  14. Elsayed HH, Hassaballa A, Ahmed T. Is video-assisted thoracoscopic surgery talc pleurodesis superior to talc pleurodesis via tube thoracostomy in patients with secondary spontaneous pneumothorax? Interact Cardiovasc Thorac Surg. 2016;23:459–61.

    Article  PubMed  Google Scholar 

  15. Noppen M, Meysman M, d’Haese J, Monsieur I, Verhaeghe W, Schlesser M, et al. Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax. Eur Respir J. 1997;10:412–6.

    Article  CAS  PubMed  Google Scholar 

  16. Morikawa S, Okamura T, Minezawa T, Goto Y, Hayashi M, Yamaguchi T, et al. A simple method of bronchial occlusion with silicone spigots (Endobronchial Watanabe Spigot; EWS®) using a curette. Ther Adv Respir Dis. 2016;10:518–24.

    Article  PubMed  Google Scholar 

  17. Mukaida T, Andou A, Date H, Aoe M, Shimizu N. Thoracoscopic operation for secondary pneumothorax under local and epidural anesthesia in high-risk patients. Ann Thorac Surg. 1998;65:924–6.

    Article  CAS  PubMed  Google Scholar 

  18. Galvez C, Bolufer S, Navarro-Martinez J, Lirio F, Corcoles JM, Rodriguez-Paniagua JM. Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax. Ann Transl Med. 2015;3:104.

    PubMed  PubMed Central  Google Scholar 

  19. Noda M, Okada Y, Maeda S, Sado T, Sakurada A, Hoshikawa Y, et al. Is there a benefit of awake thoracoscopic surgery in patients with secondary spontaneous pneumothorax? J Thorac Cardiovasc Surg. 2012;143:613–6.

    Article  PubMed  Google Scholar 

  20. Kim SJ, Lee HS, Kim HS, Shin HS, Lee JW, Kim KI, et al. Outcome of video-assisted thoracoscopic surgery for spontaneous secondary pneumothorax. Korean J Thorac Cardiovasc Surg. 2011;44:225–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Matsuoka K, Kuroda A, Kang A, Imanishi N, Nagai S, Ueda M, et al. Surgical results of video-assisted thoracic surgery and risk factors for prolonged hospitalization for secondary pneumothorax in elderly patients. Ann Thorac Cardiovasc Surg. 2013;19:18–23.

    Article  PubMed  Google Scholar 

  22. Park KT. The usefulness of two-port video-assisted thoracoscopic surgery in low-risk patients with secondary spontaneous pneumothorax compared with open thoracotomy. Ann Thorac Med. 2014;9:29–32.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Isaka M, Asai K, Urabe N. Surgery for secondary spontaneous pneumothorax: risk factors for recurrence and morbidity. Interact Cardiovasc Thorac Surg. 2013;17:247–52.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ichinose J, Nagayama K, Hino H, Nitadori J, Anraku M, Murakawa T, et al. Results of surgical treatment for secondary spontaneous pneumothorax according to underlying diseases. Eur J Cardiothorac Surg. 2016;49:1132–6.

    Article  PubMed  Google Scholar 

  25. Nakajima J, Takamoto S, Murakawa T, Fukami T, Yoshida Y, Kusakabe M. Outcomes of thoracoscopic management of secondary pneumothorax in patients with COPD and interstitial pulmonary fibrosis. Surg Endosc. 2009;23:1536–40.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors appreciate the contributions of all of the surgeons and respiratory physicians who participated in this manuscript.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222-1, Kamikitatesaruta, Akita, Akita, 010-1495, Japan

    Yoshitaro Saito, Yohei Suzuki, Ryo Demura & Hideki Kawai

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  1. Yoshitaro Saito
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  2. Yohei Suzuki
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  3. Ryo Demura
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  4. Hideki Kawai
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Correspondence to Yoshitaro Saito.

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Saito, Y., Suzuki, Y., Demura, R. et al. The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax. Surg Today 48, 320–324 (2018). https://doi.org/10.1007/s00595-017-1585-8

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