06. tbl. 108. árg. 2022
Short- andlong-term outcomes following surgery for primary spontaneouspneumothorax in Iceland
Árangur skurðaðgerða við frumkomnu sjálfsprottnu loftbrjósti á Íslandi
Þórdís Magnadóttir1
Leon Arnar Heitmann2
Tinna Harper Arnardóttir1
Tómas Þór Kristjánsson1
Per Martin Silverborn1
Martin Ingi Sigurðsson2,3
Tómas Guðbjartsson1,2
1Departments of Cardiothoracic Surgery, Landspitali University Hospital, 2Faculty of Medicine, University of Iceland, 3Anesthesia and Intensive Care, Landspitali University Hospital.
Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is
Key words: primary spontaneous pneumothorax, outcomes, recurrence, smoking.
BACKGROUND: Primary spontaneous pneumothorax (PSP) is a common disease where surgery is indicated for persistant air leak or recurrent pneumothorax. We studied the outcomes of PSP-surgery over a 28 year period in a whole nation.
MATERIALS AND METHODS: A retrospective study on 386 patients (median age 24 years, 78% males) that underwent 430 PSP surgeries at Landspitali University Hospital 1991-2018. Annual incidence of the procedure was calculated and previous medical history, indication and type of surgery, complications and length of hospital stay were registered. Patients in four 7 year periods were compared, recurrent pneumothoraces requiring reoperation (median follow-up 16 years) registered and predictors of reoperation identified with logistic regression.
RESULTS: Annually 14.5 PSP surgeries (median, range 9-27) were performed; the incidence decreasing by 2.9% per year on average. Every other patient smoked and 77% of surgeries were performed with video assisted thoracocopic surgery (VATS). The most common early complications (<30 days from surgery) were persistent airleak (17%), pneumonia (2%) and empyema (0,5%). No patient died within 30 days from surgery. Reoperation for recurrent pneumothorax was performed on 27 patients; 24 following VATS (7%), median time from the primary surgery being 16 months. Logistic regression showed that younger patients were more likely to require reoperation for recurrent pneumothorax.
CONCLUSIONS: Surgical treament for PSP is safe and major early complications rare. The rate of recurrent pneumothorax requiring surgery was 6%, which is similar to other studies. For unknown reasons the incidence of PSP surgery declined, but future research has to answer if it is linked to decreased smoking in the Icelandic population.
*Information regarding weight was missing for 23 patients**Information regarding height of 57 patients was missing
Table II. Indication for surgery |
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1991-2018 | 1991-1997 | 1998-2004 | 2005-2011 | 2012-2018 | |
First pneumothorax | 191 (44) | 50 (41) | 42 (42) | 48 (41) | 51 (55) |
First recurrent pneumothorax | 178 (41) | 48 (40) | 36 (36) | 57 (49) | 37 (40) |
Second or third recurrent pneumothorax | 56 (13) | 19 (16) | 20 (20) | 12 (10) | 5 (5) |
>3 recurrences on ipsilateral lung | 5 (1) | 4 (3) | 1 (1) | 0 | 0 |
Bilateral pneumothorax | 1 (1) | 0 | 1 (1) | 0 | 0 |
Table III. Type of surgery, length of surgery og length of hospital stay after surgery
1991-2018 | 1991-1997 | 1998-2004 | 2005-2011 | 2012-2018 | |
Wedge resection only | 161 (37) | 68 (56) | 57 (58) | 19 (16) | 17 (18) |
Wedge resection + pleurodesis | 216 (50) | 52 (43) | 41 (41) | 58 (50) | 65 (70) |
Wedge resection + pleurodesis + partial pleurectomy | 51 (12) | 0 (0,0) | 1 (1) | 40 (34) | 10 (11) |
Operative time | 52 (40, 68) | 60 (40, 75) | 45 (35, 65) | 50 (42, 65) | 52 (37, 67) |
Length of hospital stay | 3 (2,5) | 3 (2, 5) | 3 (2, 4) | 4 (3, 5) | 3 (2, 4) |
Table IV. Early complications after surgery | |
Persistent airleak | 74 (17) |
Bleeding | 9 (2) |
Pneumonia | 7 (2) |
Empyema | 2 (0,5) |
Horners syndrome | 1 (0,2) |
30 day mortality | 0 (0) |
Tafla V. Independent predictors for recurrent pneumothorax after surgery for PSP. Odds ratio are shown together with 95% confidence intervals (CI)
Figure 1 Incidence during the study period. According to Poisson regression model the incidence decreased significantly, or on average by 2,9% annually.
Figure 2 Number and type of operations performed in four 7 year periods. X-axis shows year periods and y-axis shows number of operations.
Figure 3. Reversed Kaplan-Meier graph that shows the timing of the recurrent pneumothoraces from the primary surgery.