Nationwide Outcomes of Primary Spontaneous Pneumothorax in Children: Fewer Recurrences and Readmissions with Up-Front Operative Resection

Abstract

INTRODUCTION: Primary spontaneous pneumothorax (PSP) occurs most commonly in adolescent males in the pediatric population. However, considerable variation in PSP management exists. This study aims to compare nationwide treatment and outcomes of children with PSP. METHODS: The Nationwide Readmissions Database (2016 to 2017) was used to identify patients 1 to 18 years old with PSP. Trauma, secondary pneumothoraces, and elective admissions were excluded. Demographics and complications were compared among patients undergoing initial conservative nonoperative therapy (Non-Op), including observation or percutaneous drainage, or operative resection (OR) using standard statistical tests. RESULTS: A total of 3,980 patients were identified with PSP. Most were adolescent (age 16 [interquartile range 14 to 17] years) males (80%). The majority (78%) underwent Non-Op, of which 30% did not receive drainage, and 17% failed Non-Op requiring OR. Of the intent-to-treat cohort (any initial index Non-Op), 28% failed Non-Op during index admission or required repeat percutaneous drainage or on readmission. Patients treated by Non-Op experienced shorter index length of stay (3 [2 to 6] vs 6 [4 to 10] days) and higher 30-day and overall readmission rates compared with OR (all p < 0.001). Ipsilateral recurrent pneumothorax was higher in those receiving Non-Op (13% vs 3% OR, p < 0.001), and other readmission complications were similar (Table 1). Of those treated by index Non-Op, 5% received OR and 14% received repeat Non-Op during readmission. Table 1. - Readmission Complications and Treatments Among Pediatric Patients with Primary Spontaneous Pneumothorax Readmissions complications and procedures Conservative nonoperative therapy n = 3,120 (78%) Operative resection n = 770 (22%) p Value Postprocedural air leak <1% <1% 1.00 Bleeding <1% <1% 0.095 Effusion 1% 1% 0.321 Ipsilateral pneumothorax 13% 3% <0.001 Contralateral pneumothorax 2% 8% <0.001 Percutaneous drainage 4% 1% <0.001 Operative resection 9% 5% <0.001 Readmission within 30 days 16% 5% <0.001 Readmission within 365 days 29% 15% <0.001 CONCLUSION: In this nationwide cohort, patients with PSP who underwent initial Non-Op therapy experienced significantly higher failure and readmission rates than those receiving OR. This information should be used by surgeons when selecting individual approaches for PSP.