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The Journal of Cardiovascular Surgery 1998 February;39(1):107-11

language: English

Spontaneous pneu­moth­o­rax: deter­mi­nants of sur­gi­cal inter­ven­tion

Satinder J. K., Al-Kattan K. M., Hamdy M. G.

From ­the Division of Thoracic Surgery Riyadh Medical Complex, Riyadh, Saudi Arabia


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Objective. To ­assess ­the ­long ­term effi­ca­cy of inter­cos­tal ­tube drain­age ­for spon­ta­ne­ous pneu­moth­o­rax ­and deter­mine ­the clin­i­cal param­e­ters asso­ciat­ed ­with sur­gery.
Experimental ­design. Retrospective anal­y­sis ­with a ­mean fol­low-up of 62.3±19.3 ­months (­range 23 to 94 ­months).
Setting. Riyadh Medical Complex, Riyadh (Saudi Arabia), ­the ­biggest refer­ral cen­tres ­for Ministry of Health pro­vid­ing spe­cial­ized hos­pi­tal ­care.
Patients. Over a peri­od of ­six ­year, 123 ­patients ­had 182 epi­sodes of spon­ta­ne­ous pneu­moth­o­rax. Male to ­female ­ratio ­was 29.75:1 (p=0.00001). Average ­age ­was 26.35±8.33 ­years ­for ­men ­and 37.25±14.6 ­years ­for wom­en (p=0.01). Seventy ­eight ­per ­cent of ­patients ­were ­aged 11 to 30 ­years (p=0.00001). Majority ­were non­smok­ers (100/123, p=0.00001). It ­was ­first epi­sode of spon­ta­ne­ous pneu­moth­o­rax ­for 86 ­patients. Other 37 ­patients ­had 57 epi­sodes pre­vi­ous­ly (­mean 1.54±0.73; ­range 1 to 4).
Interventions. Intercostal ­tube drain­age ­for ­all ­patient ­with spon­ta­ne­ous pneu­moth­o­rax. Limited axil­lary thor­a­cot­o­my ­with bul­lec­to­my ­and pleu­roa­bra­sion ­for 32 ­patients ­not respond­ing to inter­cos­tal ­tube drain­age.
Results. Intercostal ­tube drain­age ­alone ­had suc­cess ­rate of 90.7% in ­first, 52.4% in sec­ond, 15.4% in ­third ­and 0% ­for ­more ­than 3 epi­sodes of spon­ta­ne­ous pneu­moth­o­rax. Among ­the 32 ­patients ­who under­went sur­gery, ­only ­one ­had ear­ly recur­rence ­that ­did ­not ­require drain­age. We ­found ­that ­patients ­with his­to­ry of recur­rence, res­pir­a­to­ry dis­tress ­and ­those requir­ing ­tube thor­a­cos­to­my ­for ­more ­than 4 ­days ­and neg­a­tive suc­tion to ­expand ­the ­lung ­were ­more ­liable to under­go sur­gi­cal inter­ven­tion (p=0.00001 ­for ­all var­i­ables).
Conclusions. We rec­om­mend ear­ly sur­gery to has­ten recov­ery ­and short­en ­the hos­pi­tal ­stay in ­patients ­with his­to­ry of recur­rent spon­ta­ne­ous pneu­moth­o­rax, res­pir­a­to­ry dis­tress ­and ­those requir­ing ­tube thor­a­cos­to­my ­for ­more ­than 4 ­days ­and neg­a­tive suc­tion to ­expand ­the ­lung.

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