Highlights
- •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.
Abstract
Introduction
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.
Methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: March 20, 2023
Accepted:
February 17,
2023
Received in revised form:
January 10,
2023
Received:
October 7,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
