Abstract
Background: Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. The socioeconomic impact of recurrent PSP on the healthcare system is insufficiently reported. Methods: Ninety-six patients treated for PSP between 01/2010 and 01/2020 were included. Forty-eight patients underwent primary VATS, while the second group received chest tube (CT) treatment only. Length of hospital stay (LOS), duration of chest tube, prolonged air leak, postoperative complications, recurrences and treatment costs were analyzed. Results: Prolonged air leaks were evident in 12.5% and 22.9% patients of the VATS and CT group, respectively. Ten (20.8%) patients in the CT group underwent VATS for persistent air leakage. During follow-up, the VATS group recurred at 8.3% compared to 52.1% in the CT group. The total cost of treatment per patient, including treatment cost due to recurrence, was EUR 1.501 in the VATS group and EUR 2.233 in the CT group. Conclusions: Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP.
Highlights
According to the German S3 guidelines [1], primary spontaneous pneumothorax (PSP)describes the presence of air without preceding trauma or underlying pulmonary disease within the pleural space of patients under 45 years of age
We wondered if preventive surgical intervention might be a suitable alternative to reduce the recurrence rates and associated economic burden, as well as to mitigate the negative psychological impact that results from anxiety about a potential recurrence [15]
We retrospectively reviewed the data of 96 patients with PSP treated in our institution either by chest tube (CT) or video-assisted thoracoscopic surgery (VATS) between January 2010 and January 2020
Summary
According to the German S3 guidelines [1], primary spontaneous pneumothorax (PSP)describes the presence of air without preceding trauma or underlying pulmonary disease within the pleural space of patients under 45 years of age. In cases with ipsilateral or contralateral recurrence of PSP and for those with persistent air leak following chest tube (CT) treatment, the guidelines [1,4,5,6] recommend video-assisted thoracoscopic surgery (VATS). Current guidelines recommend video-assisted thoracoscopic surgery (VATS) for recurrent primary spontaneous pneumothorax (PSP) and for cases with persistent air leak after chest tube treatment. Conclusions: Primary treatment of PSP by CT is associated with an increased socioeconomic burden for patients and the healthcare system due to high recurrence rates. This burden may be reduced if VATS is considered at the first episode of PSP
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