Spontaneous Pneumothorax In Children Research Articles

Surgical management of spontaneous pneumothorax in children

Surgical management of spontaneous pneumothorax in children

Aggressive approach for spontaneous pneumothorax treatment in children with Marfan syndrome?

Marfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients. Retrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10-June 22), with special emphasis on diagnosis, treatment, and follow-up (FU). Sixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up. Treatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population.

Conservative and operative management of spontaneous pneumothorax in children and adolescents: Are we abusing of CT?

No age-specific pediatric guidelines exist for the management of spontaneous pneumothorax (SP) in children and adolescents. Treatment remains heterogeneous and center dependent. The role of computed tomography (CT) has yet to be defined. Review the management of SP in children and adolescents, with emphasis on conservative management and role of CT. Retrospective analysis of 61 consecutive patients with SP at single tertiary center. Clinical, radiological, surgical data, follow-up, and outcomes were revised. First-line management was conservative for 32 (53%) patients and operative for 29 (47%). Asymptomatic/paucisymptomatic patients managed conservatively experienced less first-line treatment failure. Furthermore, the patients needing at least a chest drain or surgery during the follow-up were significantly lower in the conservative group. Conservative and operative patients showed no significant differences regarding ipsilateral recurrences or contralateral occurrences. Of the 61 overall CTs performed, 14 (23%) had an impact on management. Forty-three (70%) patients had at least a CT, in 22 (51%) the CT was positive for blebs. For 10 of these patients (45%) the presence of blebs had an impact on management. Patients with and without blebs showed no differences regarding ipsilateral recurrence, contralateral occurrences, or the need for at least a chest drain or surgery during the follow-up. First-line conservative management had a significantly shorter hospitalization and better outcome, with a similar incidence of recurrences. The presence of blebs at CT does not predict the risk of recurrence. The CT scan should be reserved for a small number of selected patients who have post-VATS refractory or recurrent pneumothorax.

Pigtail Catheter versus Large Bore Chest Tube for the Management of Spontaneous Pneumothorax in Children: A Retrospective Study.

Pigtail catheter (PGC) insertion due to spontaneous pneumothorax (SPT) in the pediatric population has increased markedly in the last years. However, only few studies examined its efficacy in terms of length of hospitalization, rate of complications, and especially pain management comparing to large bore catheter (LBC) insertion. We sought to compare analgetic drug consumption, efficacy, and complication rate between PGC and LBC in children with SPT. This is a single-center retrospective study of pediatric patients that were admitted to the Schneider Children's Medical Center between 2013 and 2021 with a diagnosis of SPT. The following data were collected: type of drainage (PGC or LBC), duration of drainage, length of hospitalization, number of X-rays, complication rate, surgery during hospitalization, readmission due to SPT, and pain management. Seventeen PGC and 23 LBC were inserted in our study. No differences were noted in terms of hospitalization length, tube reposition or replacement, and recurrence of SPT between the groups. Patients with PGC underwent less X-rays comparing to the LBC group (3 X-rays vs. 5, median, p < 0.005). Oral analgesic use in terms of length of therapy was significantly lower in the PGC group than in the LBC group (1 vs. 3+ days, median, p < 0.05). There was no major complication in this cohort. PGC is an effective, safe, and less painful alternative compared with a LBC for the drainage of SPT in children.

A retrospective cohort study investigating the etiology of primary spontaneous pneumothorax in children: Radiological and genetic analysis

Background/Aim: Spontaneous pneumothorax is a serious health concern due to its life-threatening nature. It occurs when air sacs in the lungs rupture, causing air to accumulate in the chest cavity and making normal breathing difficult. Primary spontaneous pneumothorax (PSP) refers to the accumulation of air in the pleural space without any traumatic or iatrogenic cause. The objectives of our study are to identify the predisposing factors in PSP patients, determine which patients should undergo genetic analysis, and present the results of a new treatment algorithm. Methods: This study is a retrospective cohort analysis of children diagnosed with PSP and admitted to the emergency department or pediatric surgery clinic. The study evaluates demographic data, radiological findings, and molecular genetic analyses of these patients. Treatment planning was conducted using thoracic computed tomography (CT) or high-resolution computed tomography (HRCT) after the acute phase, and eligible patients were selected for genetic analysis based on syndromes commonly associated with PSP. Results: The study included 14 patients, 10 boys and four girls, with an average age of 16.14 (0.95) years. PSP was detected on the right side in nine male patients and on the left side in one male patient, while in girls, it was detected on the right side in two patients and on the left side in two patients. Radiological findings included air cysts, fibrotic changes, and pleural thickening. Folliculin (FLCN) mutation was detected in two patients after genetic analysis. Conclusion: In the stratified treatment protocol, radiological findings were used as a guide, and the detection of possible syndromic mutations by genetic analysis was deemed important for future management.

Management of primary spontaneous pneumothorax in children: Current practices among Turkish pediatric surgeons.

This study aims to evaluate current practices in the management of primary spontaneous pneumothorax among Turkish pediatric surgeons. Between October 2021 and November 2021, an online survey comprising 19 questions was delivered to all members of the Turkish Association of Pediatric Surgeons (TAPS). A total of 74 respondents (42 males, 32 females; mean age: 42.3±7.9 years; range, 29 to 61 years) were included. The response rate was 17.1% among all society members. The rate of utilization of computed tomography in the initial admission was 27.4%, and the rate of use in cases requiring surgical treatment was 78.4%. A total of 81% of surgeons reported that the size of the pneumothorax influenced management. For the first episode of primary spontaneous pneumothorax, 75.7% of surgeons opted for chest tube drainage, 14.9% for only oxygen administration, 4.1% for needle aspiration, and none of the surgeons preferred video-assisted thoracoscopic surgery. For patients with a persistent air leak after chest tube placement, there was a wide variation in the duration of observation before performing surgery. Video-assisted thoracoscopic surgery was the most preferred surgical intervention (75.3%) and the most preferred surgical method was stapled bullectomy (43.8%). There are practice variations in the management of pediatric primary spontaneous pneumothorax among the society members. However, the majority of members seem to agree on the use of computed tomography, initial treatment, and surgical interventions.

Management of the spontaneous pneumothorax in children

Introduction. Emphysematous changes in the lung tissue are the main cause of pneumothorax in children. To restore the lung function is one of the most challenging tasks in pediatric surgery.Purpose. To confirm the effectiveness of videothoracoscopy in the treatment of children with spontaneous pneumothorax.Material and methods. A retrospective analysis of case histories of 12 patients with spontaneous pneumothorax was made. Outcomes of treatment were monitored in patients during their stay in the hospital. Time of air release cessation, expansion of the lung, complications and length of stay in the hospital were analyzed.Results. In the first group of patients (n=7) only the drainage technique was used; aerostasis was achieved by the end of the second week (14.3±1.5 days). The drainage was in place till the air leakage was eliminated. The length of patient's stay in the hospital was 20.3±2.3 days. In the second group (n=5), the resection intervention was made. The complete lung expansion was achieved on the first day. Lung hermeticism was achieved by 4.2±1.3 day (p0.05). There were no any bronchopulmonary complications. The length of stay in the hospital was 14.1±1.1 days (p0.05).The advantage of the thoracoscopic technique applied for the treatment of spontaneous pneumothorax is in creating conditions for faster elimination of the source of air leakage, in accelerating functional recovery and in shortening the length of patient's stay in the hospital. The combination of thoracoscopic lung resection with pleurectomy in children can significantly reduce the risk of pneumothorax recurrence.Conclusion. To eliminate the prolonged air release in case of confirmed bullous changes in the lungs, when minimally invasive techniques are ineffective, surgical treatment in the form of video-assisted thoracoscopic resection can be applied early, even with the first episode of pneumothorax.

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

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.

European Pediatric Surgeons' Association Survey on the Management of Primary Spontaneous Pneumothorax in Children.

To evaluate the practice patterns of the European Pediatric Surgeons' Association (EUPSA) members regarding the management of primary spontaneous pneumothorax (PSP) in children. An online survey was distributed to all members of EUPSA. In total, 131 members from 44 countries participated in the survey. Interventional approach (78%) is the most common choice of treatment in the first episode, and most commonly, chest tube insertion (71%) is performed. In the case of a respiratory stable patient, 60% of the responders insert chest tubes if the pneumothorax is more than 2 cm. While 49% of surgeons prefer surgical intervention in the second episode, 42% still prefer chest tube insertion. Main indications for surgical treatment were the presence of bullae more than 2 cm (77%), and recurrent pneumothorax (76%). Eighty-four percent of surgeons prefer thoracoscopy and perform excision of bullae with safe margins (91%). To prevent recurrences, 54% of surgeons perform surgical pleurodesis with pleural abrasion (55%) and partial pleurectomy (22%). The responders who perform thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the surgeons performing open surgery (p < 0.05). Most of the responders prefer chest tube insertion in the management of first episode of PSP and perform surgical treatment in the second episode in case of underlying bullae more than 2 cm and recurrent pneumothorax. The surgeons performing thoracoscopy use more surgical pleurodesis and prefer shorter chest tube duration than the responders performing open surgery. The development of evidence-based guidelines may help standardize care and improve outcomes in children with PSP.

Primary spontaneous pneumothorax in children: A single institutional experience

The treatment of primary spontaneous pneumothorax (PSP) remains controversial. We aimed to examine the role of chest computed tomography (CT), the advantages of pigtail catheter versus chest tube regarding duration of drainage or hospitalization period, and the impact of small PSP and surgical treatment on recurrence rate. We retrospectively reviewed the medical records of 109 children with PSP (20 years' period). Patients with recurrent and those with non-recurrent PSP were compared. We recorded 183 episodes of PSP (45% recurrences), 89 patients (97%) were male, and the median age at presentation was 16 years. There were no significant differences between recurrence and non-recurrence PSP regarding age, gender, medical background, presentation symptoms, type of chest drain, median hospitalization length and median follow-up period. Recurrences were less frequent among patients who presented with small PSP and were treated conservatively (P=0.029). PSP was almost always unilateral and the recurrence was observed ipsilateral in almost 80% of the cases. CT was more frequently used and blebs/bullae were more frequently found among patients with recurrent PSP. Pigtail use had no advantage in reducing hospitalization period and surgical procedures prevented recurrences. The size of pneumothorax at presentation helps to predict recurrences. There are no differences regarding duration of drainage or hospitalization period in the use of pigtail compared to chest tube. CT helps evaluate findings in the lungs in recurrent cases of PSP and surgery prevents recurrences effectively.

Review of thoracoscopic excision of bullae/bleb for the treatment of spontaneous pneumothorax in children

A systematic review of the literature was performed to evaluate the results and outcomes of the thoracoscopic bullae and/bleb excision (TBBE) for the treatment of spontaneous pneumothorax (SP) in children. An electronic search of MEDLINE and PUBMED was performed by using the keywords: thoracoscopy’, ‘spontaneous pneumothorax’, ‘bullae’, ‘bleb’ and ‘children’. The selected articles searched for demographic features, localization of blebs and preoperative computed tomography (CT) findings. The operative time, postoperative outcomes (duration of chest tube and length of hospital stay) and complications (air leak, failure and recurrence) were also recorded. Eighteen studies include 814 cases in which 57% (n = 464) of them associated with bullae/bleb. The mean age of patients was 14.8 years. 82.8% of patients were male. The left side was the most common localization. Bullae/blebs were defined in 31.3% (n = 144) of preoperative CT scans. The mean operative time showed a range of 55–85 min depending on the surgical procedure. Five of the studies reported the duration of postoperative chest tube drainage ranging from 3.3 to 25 days. The mean hospital stay was 4.3–10 days. The complications were bleeding (n = 1), postoperative air leaks (n = 6) and Bernard-Horner Syndrome (n = 1). The recurrence rates were reported in 4–30% of all the TBBE procedures. TBBE is a safe and effective treatment for SP in children. TBBE has several advantages over thoracotomy, including less recurrence and complication rates. The timing of the thoracoscopic excision, the best surgical instruments that would lead to less complications, and optimum treatment of recurrence still need to be addressed.

Feasibility of a Standardized Management for Primary Spontaneous Pneumothorax in Children and Adolescents: A Retrospective Multicenter Study and Review of the Literature.

Introduction: The management of primary spontaneous pneumothorax (PSP) in children still remains controversial. The current literature shows a lack of scientific evidence supporting a standardized management. Materials and Methods: A multicenter retrospective study was performed, patients admitted for PSP in five Pediatric Surgical Units over a 9-year period (from 2008 to 2017) were included. Patient data were reviewed for each case. Management and outcomes were statistically analyzed. Results: Overall 159 patients (135 males and 24 females) were included in this study. During the first hospital admission, 62/159 patients (39%) were conservatively managed with oxygen therapy; 95/159 patients (60%) required a chest drain insertion; 2/159 patients (1%) underwent surgery because of a bilateral pneumothorax. Thoracoscopy was performed in 75/159 (47%) patients after the second hospital admission or for persistent air leak during the first access. Postoperatively, 8/75 (11%) patients developed recurrent pneumothorax requiring chest drain insertion in 3/8 (37%) cases or aspiration in 1/8 (13%), whereas 4/8 (50%) patients were conservatively managed. All of the patients but one, were confirmed to be affected by emphysematous-like changes at histology. Conclusions: Despite the limitations of being a retrospective study, we suggest that the early surgical management in children with PSP is feasible and safe and it seems to significantly reduce the recurrence rate. To the best of our knowledge there are no pediatric guidelines for the management of PSP, therefore, we support the need for prospective studies to create the evidence-based pillars for correct and standardized management of this condition.

Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence.

The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes. We reviewed children aged < 18years admitted to our institution for PSP from 2008 to 2017, excluding those with malignancies. Basic demographic data were extracted. Clinical data collected include pneumothorax laterality, CT results, treatment protocols and recurrences. 63 patients were included, 19 (30.2%) of whom had CT scans. A total of 41 surgeries were performed. The median (interquartile range) age was 15.4years (14.9-15.9), and body-mass index was 17.9kg/m2 (15.8-19.3). 56 (88.9%) patients were male. Median follow-up duration was 19.8months (11.6-35.9). Multivariate logistic regression analyses identified surgery in the first episode as a predictor for a subsequent contralateral occurrence (odds ratio [95% confidence interval] 32.026 [1.685-608.518], p = 0.021). No predictors for ipsilateral recurrence were found. CT scans were 76.5% sensitive for bleb detection, and predicted poorly for occurrence (positive predictive value 14.3%, likelihood ratio 1.1). This is the first study demonstrating that surgery at first presentation appears to predict for occurrence of PSP on the contralateral lung. CT appears to be ineffective in detecting blebs and predicting PSP occurrence.

Management of Spontaneous Pneumothorax in Children: A Systematic Review and Meta-Analysis.

Management of primary spontaneous pneumothorax (PSP) is mainly based on adults. Data are controversial with regards to its management in children. We aimed to assess: (1) the length of hospital stay (LOS) between conservative management (i.e., observation with O2 administration), aspiration/chest drain, and surgical management; (2) the risk of recurrence after nonsurgical treatment versus surgery; (3) the risk of recurrence in the presence of bullae. Using a defined search strategy, three independent investigators identified all the studies on the management of PSP in children. Case reports, opinion articles, and gray literature publications were excluded. The study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was performed using RevMan 5.3. Data are expressed as mean ± SD. Of 3,089 abstracts screened, 95 full-text were analyzed, 23 were included in the quantitative analysis, and 16 were included in the meta-analysis (1,633 patients). LOS was similar between conservative and surgical management (6.2 ± 0.8 days vs. 5.9 ± 1.4 days; p = ns). Recurrence of PSP was significantly higher among children with a nonsurgical management (32%) versus those surgically treated (18%; p = 0.002). The incidence of recurrence was slightly higher in patients managed by aspiration/chest drain (34%) compared with those with a conservative management (27%; p = 0.05). Risk of recurrence in patients with or without documented bullae was not significantly different (26 vs. 38%, respectively; p = ns). Given the lack of a standardized management of pediatric PSP, the present study seems to demonstrate a better outcome in children treated with surgery as first-line of management. This is a Level III study.

Spontaneous pneumothorax in children

Spontaneous pneumothorax in children

The influence of pleurodesis on the outcome of primary spontaneous pneumothorax in children.

Primary spontaneous pneumothorax (PSP) has a high rate of recurrence, and pleurodesis has been shown to decrease the rate of recurrence in adult PSP. For pediatric PSP patients, there are only a few case series available and evidence on the benefits of pleurodesis is insufficient. This study aimed to analyze the outcome of pleurodesis among pediatric PSP patients via a nationwide population-based cohort in Taiwan. The hospitalization data from the pediatric intensive care sampling file of the National Health Insurance Research Database from January 1 to December 31, 2010, were retrieved and analyzed. Children aged 0-18 years with a discharge diagnosis of PSP (ICD-9: 512, 512.0, and 512.8) were enrolled in the study. Demographic data, management strategies, and clinical outcomes were recorded and analyzed as well. A total of 1005 hospitalization cases were identified and divided into the pleurodesis (409 hospitalizations) and nonpleurodesis (596 hospitalizations) groups. In the univariate analysis, thoracoscopic surgery for PSP decreased the incidence of recurrence (hazard ratio [HR], 0.46; 95% CI, 0.32-0.67) and the need for further surgical intervention (HR, 0.29; 95% CI, 0.18-0.47); however, conventional open surgery did not. A lesser incidence of PSP recurrence (HR, 0.53; 95% CI, 0.37-0.78) and fewer subsequent surgical interventions (HR, 0.32; 95% CI, 0.20-0.52) were found in the pleurodesis group in comparison with the nonpleurodesis group. A multivariate Cox regression analysis revealed that pleurodesis was the only significant factor capable of decreasing the incidence of PSP recurrence (HR, 0.57; 95% CI, 0.38-0.86) and the need for further surgical intervention (HR, 0.40; 95% CI, 0.23-0.69). Pleurodesis reduces the rate of recurrence and the need for further surgical intervention in pediatric PSP. It may be considered as the method of choice for the management of PSP in children.

Primary spontaneous pneumothorax in children and adolescents: a systematic review

Primary spontaneous pneumothorax (PSP) is common in young population. But despite its incidence, specific guidelines for pediatric patients are not available and an agreement on the optimal management of this pathology has not been reached yet. Current protocols for treatment of PSP are not up to date at genetic and pathologic advances, remaining those of 20th century. If the presence of blebs and bullae in the apex of the lung is still considered the principal determinant for PSP, the process underlying their formation is not completely clarified. Research on connective tissue pathology and on elastogenesis pathway allowed physicians to identify further predisposing factors for the onset of PSP, for that reason the belief that this disease occurs in “otherwise normal lungs” might be reviewed. For pediatric patients, a more accurate risk stratification of PSP and a specific tailored strategy are required. When inherited or acquired predisposing factors are present, children and adolescents have a higher likelihood to develop PSP than adults, and an early surgical treatment can be proposed. When surgery is needed, mini-invasive approaches are the option of choice. After the advent of videothoracoscopy, surgical techniques have been developed up to a single incision thoracoscopic surgery which allows better outcomes and can be more accepted by younger patients. The aim of this review is to summarize the last thirty years of literature on PSP in young patients, to focus the evidences which can improve the management of this disease.

Management and recurrence of spontaneous pneumothorax in children.

No guideline clearly prescribes an approach to management of spontaneous pneumothorax in children. The objectives of this study were to evaluate practice variation in the management of spontaneous pneumothorax in children and its probability of recurrence. This study was a retrospective chart review followed by a phone follow-up that included all children who had visited a tertiary care paediatric hospital for a first episode of spontaneous pneumothorax between 2008 and 2017. The primary outcomes were the management of pneumothorax (observation, oxygen, needle aspiration, intercostal chest tube, surgery) and the probability of recurrence. All charts were evaluated by a rater using a standardized report form and 10% of the charts were evaluated in duplicate. All children/families were contacted by phone to assess recurrence. The primary analyses were the proportions of each treatment modalities and recurrence, respectively. During the study period, 76 children were deemed eligible for the study. Among them, 59 had a primary spontaneous pneumothorax while 17 were secondary. The most common first therapeutic approaches were chest tube insertion (31), oxygen alone (27), and observation (14). A total of 54 patients were available for follow-up among whom a recurrence was observed in 28 (37% of the total cohort or 52% of available children). Chest tube insertion was the first line of treatment in about 40% of children with a first spontaneous pneumothorax. In this population, the recurrence probability is established between 37 and 52% and the majority occurs in the following months.

Current Practice in the Management of Spontaneous Pneumothorax in Children.

There is a lack of pediatric-specific guidelines for the workup and management of primary spontaneous pneumothorax (PSP) in children. The aim of this study was to describe current practices among North American pediatric surgeons. An online survey comprising 18 questions was sent out through the American Pediatric Surgical Association Outcomes and Clinical Trials Committee to all members. Bivariate analysis was performed using Chi-square analysis. A total of 287 surveys were completed (33% response rate). For a first episode of PSP, 57% of surgeons opt for chest tube drainage, 4% for upfront video-assisted thoracoscopic surgery (VATS), 3% for needle aspiration, and 29% for only oxygen administration. Eighty-one percent of surgeons report that the size of the pneumothorax influences management. However, neither practice setting (P = .87) nor years in practice (P = .11) correlated with initial management strategy. For patients with a persistent air leak after chest tube placement, there is wide variation in duration of observation before performing VATS, with 40% operating after 3 days, but 21% waiting at least 5 days. The use of chest computed tomography (CT) is also highly variable. Eighty-two percent of respondents perform surgery only after the second episode of PSP. Most perform a stapled apical blebectomy and mechanical pleurodesis for both initial and recurrent PSP. There is significant variation among pediatric surgeons in the management of spontaneous pneumothorax, including the use of CT, timing of operation, and duration of observation for air leak before performing surgery. Prospective data are needed to better inform guidelines and standardize practice.

Early surgical intervention is indicated for recurrent spontaneous pneumothorax in children and adolescents

Background: Primary spontaneous pneumothorax (PSP) occurs most often in adolescent patients. There is consensus that surgical intervention plays an important role in preventing recurrence, however, the optimum timing of surgery is debated. We hypothesize that clinical and radiographic factors are associated with eventual need for surgery. &#x0D; Experimental Design: We searched the medical record for PSP patients between ages 9 and 21 treated from 1/1/08 to 12/31/17 and collected data on chest tube management, radiographic measurements, operative management, and recurrence. We performed univariate analysis on relationships between admission events and eventual surgery or other management strategies. &#x0D; Results: We identified 68 PSP admissions from 31 patients. Considering only first-time admissions, there was no association between eventual surgery and clinical factors and radiographic findings. The single factor associated with eventual surgery was history of pneumothorax in any lung (p=0.015). For patients with prior pneumothorax who underwent surgery, operation the day after admission would have reduced hospital stay by an average of 1.5 days (min=0, max=9) and an average of 2.2 days (min=0, max=10) if performed on the day of admission, with a mean 1.85 fewer chest x-rays (min=0, max=7). Considering only first admissions, ipsilateral recurrence rate was 16.7% after surgery, 46.7% after chest tube alone, and 100% after observation alone. &#x0D; Conclusion: This analysis suggests that though eventual surgery is difficult to predict, ipsilateral recurrence rate is reduced following surgery. Furthermore, earlier operation in recurrent patients could reduce resource utilization. Thus, expedited surgical treatment may merit consideration in patients with a history of pneumothorax.