Surgical treatment for secondary spontaneous pneumothorax: a risk factor analysis



While surgery is an effective treatment for secondary spontaneous pneumothorax (SSP), it can be difficult, because affected patients are usually in a poor general condition. The present study investigated the risk factors of postoperative complications after surgery for SSP.


Eighty-eight patients with SSP who underwent surgery from January 2006 to March 2018 were investigated. Clinical data were reviewed, and a multivariate analysis was performed.


Eighty-four patients (95%) were males, and the median patient age was 72 years. Underlying lung diseases were chronic obstructive pulmonary disease in 58 patients (65.9%), interstitial pneumonia in 26 (29.5%), and others in 4 (4.5%). Postoperative complications developed in 21 patients (24%). Hospital mortality/prolonged length of stay occurred in 6 patients (7%). A multivariate analysis showed that the preoperative performance status (performance status 0–2 vs. 3, hazard ratio: 6.570, 95% confidence interval: 1.980–21.800) was an independent predictor of postoperative complications.


Surgery for SSP contributed to early chest tube removal and favorable outcomes. However, rare fatal events occurred, and the patient performance status was a risk factor for postoperative complications. A careful evaluation of each patient’s performance status is needed to determine the need for surgical intervention for SSP.

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Secondary spontaneous pneumothorax


Video-assisted thoracoscopic surgery


Performance status


Chronic obstructive pulmonary disease


Interstitial pneumonia


Home oxygen therapy


Endobronchial Watanabe spigot


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We thank Jane Charbonneau, DVM, of Edanz Group ( for editing a draft of this manuscript.


We received no funding for this study.

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Correspondence to Takeshi Kawaguchi.

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Because this was a retrospective study, the need to obtain written informed consent from each patient was waived.

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Kawai, N., Kawaguchi, T., Yasukawa, M. et al. Surgical treatment for secondary spontaneous pneumothorax: a risk factor analysis. Surg Today (2021).

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  • Surgery
  • Secondary spontaneous pneumothorax
  • Postoperative complication
  • Risk factor