Disorders of the Pleura |

Comparing the Outcomes of Surgical vs Nonsurgical Treatment of Persistent Air-Leak in Primary Spontaneous Pneumothorax FREE TO VIEW

Tunn Ren Tay, MBBS; Akash Verma, MBBS; Augustine Tee, MBBS
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Changi General Hospital, Singapore, Singapore

Chest. 2014;146(4_MeetingAbstracts):443A. doi:10.1378/chest.1972012
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SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Management of patients with primary spontaneous pneumothorax (PSP) and persistent air-leak (PAL) varies considerably. There is no strong consensus regarding management strategy and optimal timing of surgical intervention for PAL. Our study aims to compare the outcomes of surgical versus non-surgical intervention for PAL and examine the risk factors for PAL and recurrence of pneumothorax within 1 year as this may aid selection of patients for surgical intervention.

METHODS: Retrospective study of patients seen at the emergency department of a teaching hospital in Singapore between August 2010 and December 2012 with the diagnosis of primary spontaneous pneumothorax. For patients with PAL (defined as air-leak duration of more than 5 days) we compared the outcomes between those who had surgery (SG) and those without surgery (NSG). Continuous and categorical variables were compared using Mann-Whitney U test and Fisher’s exact test respectively. Multivariate analysis was performed using logistic regression. Results are expressed as percentages, median (IQR) and odds ratio.

RESULTS: 129 patients were studied of which 28.7%, 56.6%, 0.8% and 14% underwent conventional chest tube, small bore tube with Heimlich valve, aspiration and observation respectively. For patients managed without surgery, air leak resolved by 7 days in 87.5%. 52 patients out of the total study population had PAL of which 46.2% underwent surgery. SG compared to NSG group had longer duration of tube drainage (11 (IQR 9-17) days vs 7 (IQR 6-8) days, p <0.001) and longer hospital length of stay (LOS) (11 (IQR 9-15) days vs 4 (IQR 0-7) days, p<0.001) but had trend towards lower recurrence at 1 year (8.3% vs 17.9%, p =0.43). These findings remained regardless of initial treatment modality. Of the total study population, female gender and size of pneumothorax on day 3 from onset were independent risk factors for persistent air-leak but no risk factors for recurrence could be identified.

CONCLUSIONS: Surgery did not reduce tube burden or hospital LOS in patients with PAL compared to conservative management but reduced the risk of recurrence at 1 year.

CLINICAL IMPLICATIONS: A non-surgical approach to PSP may be considered as most patients have resolution of air-leak by 7days. Should recurrence prevention be of priority, surgery can be offered at time of diagnosis without waiting for 5 days as suggested by current guidelines.

DISCLOSURE: The following authors have nothing to disclose: Tunn Ren Tay, Akash Verma, Augustine Tee

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