Thoracic Surgery| Volume 288, P28-37, August 2023

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Utilization and Outcomes of Observation for Spontaneous Pneumothorax at an Integrated Health System

Published:March 20, 2023DOI:


      • Observation is successful for both primary and secondary spontaneous pneumothoraces.
      • Observation is associated with successful resolution regardless of pneumothorax size.
      • Observation could help decrease morbidity and healthcare costs.



      Though limited, recent evidence supports observation rather than intervention for spontaneous pneumothorax management. We sought to compare the utilization and outcomes between observation and intervention for patients with primary and secondary spontaneous pneumothoraces.


      A retrospective cohort study of all adults presenting to Kaiser Permanente Northern California emergency rooms with spontaneous pneumothorax from 2016 to 2020 was performed. Those with prior pneumothoraces, tension physiology, bilateral pneumothoraces, effusions, and prior thoracic procedures or surgery on the affected side were excluded. Groups included observation versus intervention. Baseline clinicodemographic variables and outcomes were compared. Treatment was considered successful if further interventions were not required for pneumothorax resolution. Wilcoxon rank-sum tests, chi-square tests, Fischer exact tests, and multivariable logistic regression models were performed.


      Of the 386 patients with primary spontaneous pneumothorax, age, race/ethnicity, body mass index, smoking status, and the Charlson comorbidity index were not different between treatment groups. Of 86 patients with secondary spontaneous pneumothorax, age, gender, and smoking status were not different between treatment groups. Among patients with primary pneumothoraces, 83 underwent observation while 303 underwent intervention. The success rate was 92.8% for observation and 60.4% for intervention (P < 0.0001). Among patients with secondary pneumothoraces, 15 underwent observation while 71 underwent intervention, with a successful rate of 73.3% for observation and 32.4% for intervention (P = 0.003).


      Given the high success rates for observation of both small and moderate primary and secondary pneumothoraces, observation should be considered for clinically stable patients. Observation may be the superior choice for decreasing morbidity and healthcare costs.


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        • Mummadi S.R.
        • Stoller J.K.
        • Lopez R.
        • Kailasam K.
        • Gillespie C.T.
        • Hahn P.Y.
        Epidemiology of adult pleural disease in the United States.
        Chest. 2021; 160: 1534-1551
        • Hart G.J.
        • Stokes T.C.
        • Couch A.H.
        Spontaneous pneumothorax in Norfolk.
        Br J Dis Chest. 1983; 77: 164-170
        • Kaneda H.
        • Murakawa T.
        Initial management of spontaneous pneumothorax.
        Lancet Respir Med. 2015; 3: e35-e36
        • Stradling P.
        • Poole G.
        Conservative management of spontaneous pneumothorax.
        Thorax. 1966; 21: 145-149
      1. Round the World.
        Lancet. 1984; 324: 803
        • Baumann M.H.
        • Strange C.
        • Heffner J.E.
        • et al.
        Management of spontaneous pneumothorax: an American college of chest physicians Delphi consensus statement.
        Chest. 2001; 119: 590-602
        • MacDuff A.
        • Arnold A.
        • Harvey J.
        • et al.
        Management of spontaneous pneumothorax: British thoracic society pleural disease guideline 2010.
        Thorax. 2010; 65 Suppl 2: ii18-ii31
        • Schnell J.
        • Beer M.
        • Eggeling S.
        • et al.
        Management of spontaneous pneumothorax and post-interventional pneumothorax: German S3 guideline.
        Respiration. 2019; 97: 370-402
        • Brown S.G.A.
        • Ball E.L.
        • Perrin K.
        • et al.
        Conservative versus interventional treatment for spontaneous pneumothorax.
        N Engl J Med. 2020; 382: 405-415
        • Althouse A.D.
        Adjust for multiple comparisons? It’s not that simple.
        Ann Thorac Surg. 2016; 101: 1644-1645
        • Bobbio A.
        • Dechartres A.
        • Bouam S.
        • et al.
        Epidemiology of spontaneous pneumothorax: gender-related differences.
        Thorax. 2015; 70: 653-658
        • Gupta D.
        • Hansell A.
        • Nichols T.
        • Duong T.
        • Ayres J.G.
        • Strachan D.
        Epidemiology of pneumothorax in England.
        Thorax. 2000; 55: 666-671
        • Kelly A.M.
        • Kerr D.
        • Clooney M.
        Outcomes of emergency department patients treated for primary spontaneous pneumothorax.
        Chest. 2008; 134: 1033-1036
        • Brown S.G.A.
        • Ball E.L.
        • Macdonald S.P.J.
        • Wright C.
        • Taylor D.McD.
        Spontaneous pneumothorax; a multicentre retrospective analysis of emergency treatment, complications, and outcomes.
        Intern Med J. 2014; 44: 450-457
        • Balta C.
        • Kuzucuoglu M.
        Conservative treatment approach in primary spontaneous pneumothorax.
        J Coll Physicians Surg Pak. 2020; 30: 168-171
        • Massongo M.
        • Leroy S.
        • Scherpereel A.
        • et al.
        Outpatient management of primary spontaneous pneumothorax: a prospective study.
        Eur Respir J. 2014; 43: 582-590
        • Chew R.
        • Gerhardy B.
        • Simpson G.
        Conservative versus invasive treatment of primary spontaneous pneumothorax: a retrospective cohort study.
        Acute Med Surg. 2014; 1: 195-199
        • Gerhardy B.C.
        • Simpson G.
        Conservative versus invasive management of secondary spontaneous pneumothorax: a retrospective cohort study.
        Acute Med Surg. 2021; 8: e663
        • Liu W.L.
        • Lv K.
        • Deng H.S.
        • Hong Q.C.
        Comparison of efficiency and safety of conservative versus interventional management for primary spontaneous pneumothorax: a meta-analysis.
        Am J Emerg Med. 2021; 45: 352-357