Surgical treatment for secondary spontaneous pneumothorax: a risk factor analysis

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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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Abbreviations

SSP:

Secondary spontaneous pneumothorax

VATS:

Video-assisted thoracoscopic surgery

PS:

Performance status

COPD:

Chronic obstructive pulmonary disease

IP:

Interstitial pneumonia

HOT:

Home oxygen therapy

EWS:

Endobronchial Watanabe spigot

References

  1. 1.

    MacDuff A, Arnold A, Harvey J. Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii18-31.

    Article  Google Scholar 

  2. 2.

    Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342:868–74.

    CAS  Article  Google Scholar 

  3. 3.

    Ueda Y, Osada H, Osugi H. Thoracic and cardiovascular surgery in Japan during 2005. Gen Thorac Cardiovasc Surg. 2007;55:377–99.

    Article  Google Scholar 

  4. 4.

    Shimizu H, Endo S, Natsugoe S, Doki Y, Hirata Y, Kobayashi J, et al. Thoracic and cardiovascular surgery in Japan in 2016. Gen Thorac Cardiovasc Surg. 2019;67:377–411.

    Article  Google Scholar 

  5. 5.

    Baumann MH, Strange C, Heffner JE, Light L, Kirby TJ, Klein J, et al. Management of spontaneous pneumothorax. Chest. 2001;119:590–602.

    CAS  Article  Google Scholar 

  6. 6.

    Hence JM, Martin JT, Mullett TW. Endobronchial valves in the treatment of persistent air leaks. Ann Thorac Surg. 2015;100:1780–6.

    Article  Google Scholar 

  7. 7.

    Kanda H, Minami K, Nakano T, Taniguchi Y, Saito T, Konobu T, et al. Efficacy and long-term clinical outcome of bronchial occlusion with endobronchial Watanabe spigots for persistent air leaks. Respir Investig. 2015;53:30–6.

    Article  Google Scholar 

  8. 8.

    Kurihara M, Kataoka H, Ishikawa A, Endo R. Latest treatments for spontaneous pneumothorax. Gen Thorac Cardiovasc Surg. 2010;58:113–9.

    Article  Google Scholar 

  9. 9.

    Saito Y, Suzuki Y, Demura R, Kawai H. The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax. Surg Today. 2018;48:320–4.

    Article  Google Scholar 

  10. 10.

    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 disease. Eur J Cardiothorac Surg. 2016;49:1132–6.

    Article  Google Scholar 

  11. 11.

    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  Google Scholar 

  12. 12.

    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  Google Scholar 

  13. 13.

    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  Google Scholar 

  14. 14.

    Clavein PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavein-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  15. 15.

    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    CAS  Article  Google Scholar 

  16. 16.

    Porcel JM. Secondary spontaneous pneumothorax in idiopathic pulmonary fibrosis: Grim news. Respirology. 2018;23:448–9.

    Article  Google Scholar 

  17. 17.

    Nishimoto K, Fujisawa T, Yoshimura K, Enomoto Y, Enomoto N, Nakamura Y, et al. The prognostic significance of pneumothorax in patients with idiopathic pulmonary fibrosis. Respirology. 2018;23:519–25.

    Article  Google Scholar 

  18. 18.

    Watanabe T, Fukai I, Okuda K, Moriyama S, Haneda H, Kawano O, et al. Talc pleurodesis for secondary pneumothorax in elderly patients with persistent air leak. J Thorac Dis. 2019;11:171–6.

    Article  Google Scholar 

  19. 19.

    Qin SL, Huang JB, Yang YL, Xian L. Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis. J Thorac Dis. 2015;7:2274–87.

    PubMed  PubMed Central  Google Scholar 

  20. 20.

    Yasuda M, Nakanishi R, Mori M, Ashikari S, Oyama T, Hanagiri T. Simple covering technique in thoracoscopic bullectomy for spontaneous pneumothorax. J Thorac Dis. 2017;9:4584–8.

    Article  Google Scholar 

  21. 21.

    Deguchi H, Tomoyasu M, Shigeeda W, Kaneko Y, Kanno H, Saito H. Reduction for air leakage using linear staple device with bioabsorbable polyglycolic acid felt for pulmonary lobectomy. Gen Thorac Cardiovasc Surg. 2020;68:266–72.

    Article  Google Scholar 

  22. 22.

    Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis. 2014. https://doi.org/10.1111/codi.12490.

    Article  PubMed  Google Scholar 

  23. 23.

    Merchea A, Abdelsattar ZM, Taner T, Dean PG, Colibaseanu DT, Larson DW, et al. Outcomes of colorectal cancer arising in solid organ transplant recipients. J Gastrontest Surg. 2014;18:599–604.

    Article  Google Scholar 

  24. 24.

    Krantz SB, Mitzman B, Lutfi W, Kuchta K, Wang CH, Howington JA, et al. Neoadjuvant chemoradiation shows no survival advantage to chemotherapy alone in stage IIIA patients. Ann Thorac Surg. 2018;105:1008–16.

    Article  Google Scholar 

  25. 25.

    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  Google Scholar 

  26. 26.

    Kawachi R, Matsuwaki R, Tachibana K, Karita S, Nakazato Y, Tanaka R, et al. Thoracoscopic modified pleural tent for spontaneous pneumothorax. Interact CardioVasc Thorac Surg. 2016;23:190–5.

    Article  Google Scholar 

  27. 27.

    Chang CC, Chen YY, Chang JM, Tseng YL, Lin CY, Chuang MT, et al. Pleural tenting as an effective adjunct in patients with pneumothorax secondary to emphysema evaluated with computed tomography scan. J Thorac Dis. 2016;8:S652–8.

    Article  Google Scholar 

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Acknowledgements

We thank Jane Charbonneau, DVM, of Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

We received no funding for this study.

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Correspondence to Takeshi Kawaguchi.

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None declared.

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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). https://doi.org/10.1007/s00595-020-02206-0

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Keywords

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