Incidence of iatrogenic pneumothorax following acupuncture treatments in Taiwan

Abstract

Background: Pneumothorax is a rare complication of acupuncture and the risk factors are unclear. Objective: This study analysed the incidence of post-acupuncture pneumothorax requiring hospitalisation in a one-million-sample cohort derived from Taiwan’s National Health Insurance Research Database. Methods: We tracked this cohort between 1997 and 2012 and recorded all medical insurance information. Subjects were categorised according to gender, insurance amount, comorbidities, residential area, and number of acupuncture treatments. Pneumothorax risk was evaluated according to different demographic and medical variables by logistic regression analysis using an adjusted odds ratio (aOR) with a 95% confidence interval (95% CI). Results: Overall, 411 734 patients undergoing 5 407 378 acupuncture treatments were identified with data collected over the first 7 days after acupuncture. The incidence rates of iatrogenic pneumothorax were 0.87 per 1 000 000 acupuncture treatments overall and 1.75 per 1 000 000 acupuncture treatments in “at-risk” anatomical areas. Multivariate logistic regression demonstrated that a history of thoracic surgery (aOR 7.85, 95% CI 3.49 to 9.25), chronic bronchitis (aOR 2.61, 95% CI 1.03 to 6.87), emphysema (aOR 4.87, 95% CI 1.03 to 7.96), pneumonia (aOR 2.09, 95% CI 1.44 to 2.72), tuberculosis (aOR 3.65, 95% CI 1.39 to 9.56), and lung cancer (aOR 3.85, 95% CI 1.53 to 9.73) may increase the post-acupuncture risk of iatrogenic pneumothorax. Men had a higher risk of pneumothorax than women (aOR 3.41, 95% CI 1.36 to 8.57). The number of treatments was not associated with risk of pneumothorax. Conclusions: Patients with a history of lung disease including chronic bronchitis, emphysema, tuberculosis, lung cancer and pneumonia, and a history of thoracic surgery, might have an increased post-acupuncture risk of pneumothorax. This information may possibly help physicians avoid post-acupuncture pneumothorax.

To Explore the Effects of Acupuncture and Medical Treatment at Different Times on the Gastrointestinal Reaction and White Blood Cell Count of Patients with Lung Cancer Chemotherapy

“…Acupuncture and moxibustion therapy on patients have the effect of regulating qi and blood, channeling meridians, and improving yin and yang balance, as well as efficiently preventing and treating diseases [ 17 ]. The gastrointestinal response produced by chemotherapy may be eliminated with acupuncture at Neiguan, Zusanli, and Zhongwan; the KPS score is greatly enhanced, and the therapeutic impact of acupuncture coupled with medications is more visible [ 18 , 19 ].…”

Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review

“…However, previous reports have suggested that multiple bilateral lung punctures can lead to fatal bilateral tension pneumothoraces, even in the absence of a significant pulmonary disease background (15–18). As in this case, lung diseases, such as emphysema, are risk factors for the development of pneumothorax after acupuncture (11,14,16). A previously reported case was of a unilateral pneumothorax (14), and patients with a background of decreased respiratory capacity are more likely to have serious consequences of the occurrence of pneumothoraces.…”

“…The incidence of pneumothoraces following acupuncture is approximately ≤0.001% according to the prospective studies mentioned above (4–10), 0.87 per million sessions in a large study in Taiwan, and 1.75 per million sessions even in high‐risk sites, which is very rare (11). However, the frequency of pneumothoraces among serious adverse events, such as organ damage and death, is relatively high (12,13).…”

Acupuncture-Induced Tension Pneumothorax Presenting as Acute Heart Failure

“…Tension pneumothorax is a rare but serious and potentially fatal complication of acupuncture. A history of thoracic surgery, chronic bronchitis, emphysema, pneumonia, tuberculosis, and lung cancer may increase the postacupuncture risk of iatrogenic pneumothorax [ 7 ]. In the present case report, TSS temporarily concealed the underlying tension pneumothorax.…”