Outcome of patients with spontaneous pneumothorax admitted in Abbasia Chest Hospital

Abstract

Spontaneous pneumothorax remains a significant global problem. It can present either in a primary form occurring in healthy individuals or in a secondary form essentially associated with an underlying lung disease. The primary goals of therapy are to remove air from the pleural space and to prevent recurrence. The choice of a therapeutic intervention is multifactorial. The aim of this study was to study the clinical course and outcome of patients with spontaneous pneumothorax in Abbasia Chest Hospital. This prospective study was conducted on 100 patients with spontaneous pneumothorax admitted in Abbasia Chest Hospital in Cairo, Egypt. Patients were divided into two main groups: group I, the primary spontaneous pneumothorax (PSP) group, and group II, the secondary spontaneous pneumothorax (SSP) group. Chest tube drainage was performed for patients with large PSP, small PSP increasing in size or associated with symptoms, and all patients with SSP. Patients were subjected to thoracic surgical interventions, whenever indicated. We included 100 patients with spontaneous pneumothorax: group I (PSP) consisted of 66 patients, and group II (SSP) consisted of 34 patients. Of them, 92% were male and 8% were female. Comparison between the two groups demonstrated that PSP occurs predominantly in male population, especially younger and taller individuals, whereas there was no significant difference in weight or BMI between the two groups. An overall 77% of all studied patients were smokers. PSP patients had a shorter hospital stay compared with SSP patients. The causes of SSP were chronic obstructive pulmonary disease (64.7%), bronchial asthma (2.9%), interstitial lung diseases (14.7%), tuberculosis (17.6%), and bronchiectasis (2.9%). All patients were subjected to chest tube drainage. Complications were found in 6% of patients in group I and in 26.4% of patients in group II. Different complications were noticed in the form of surgical emphysema, hydropneumothorax, persistent air leak, and pleural infection. In group I, only one patient (1.5%) required further interventions, whereas in group II 11.7% needed surgical interventions. Mortality occurred in three patients (8.8%) in group II. There was no evidence that any mortality was directly related to pneumothorax or its management. PSP was more frequent compared with SSP in our study, with a higher incidence in younger and taller male population. Smoking is an important risk factor for spontaneous pneumothorax, and the most common lung disease found in our study to be associated with SSP was chronic obstructive pulmonary disease. We conclude that PSP carries a lesser risk for complications and better outcome compared with SSP. The risk for mortality or major complications from spontaneous pneumothorax in general was negligible in our study.