What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children?

Choi, Si Young; Park, Chan Beom; Song, Seok-Whan; Kim, Yong Hwan; Jeong, Seong Cheol; Kim, Kyung Soo; Jo, Kwang Wook

doi:10.5761/atcs.oa.13-00142

Cited by 39 publications

(27 citation statements)

References 26 publications

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“…This approach is consistent with an adult-focused Delphi consensus statement published by the American College of Chest Physicians (ACCP) in 2001 [2]. However, this strategy in children can result in long hospital stays owing to persistent air leak, followed by high recurrence rates of 40 to 61% [3][4][5][6][7][8][9]. Dissatisfaction with the outcomes of nonoperative management and advent of minimally-invasive surgery have led some surgeons to offer primary video-assisted thoracoscopic surgery (VATS) for first episode PSP [1,10] .…”

supporting

confidence: 75%

Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation

Leys

Hirschl

Kohler

et al. 2020

Journal of Pediatric Surgery

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Purpose: Chest tube (CT) management for pediatric primary spontaneous pneumothorax (PSP) is associated with long hospital stays and high recurrence rates. To streamline management, we explored simple aspiration as a test to predict need for surgery. Methods: A multi-institution, prospective pilot study of patients with first presentation for PSP at 9 children's hospitals was performed. Aspiration was performed through a pigtail catheter, followed by 6 h observation with CT clamped. If pneumothorax recurred during observation, the aspiration test failed and subsequent management was per surgeon discretion. Results: Thirty-three patients were managed with simple aspiration. Aspiration was successful in 16 of 33 (48%), while 17 (52%) failed the aspiration test and required hospitalization. Twelve who failed aspiration underwent CT management, of which 10 (83%) failed CT management owing to either persistent air leak requiring VATS or subsequent PSP recurrence. Recurrence rate was significantly greater in the group that failed aspiration compared to the group that passed aspiration [10/12 (83%) vs 7/16 (44%), respectively, P = 0.028]. Conclusion: Simple aspiration test upon presentation with PSP predicts chest tube failure with 83% positive predictive value. We recommend changing the PSP management algorithm to include an initial simple aspiration test, and if that fails, proceed directly to VATS.

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supporting

confidence: 75%

Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation

Leys

Hirschl

Kohler

et al. 2020

Journal of Pediatric Surgery

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“…Males predominated over females in our cohort by a ratio of 4:1, which is consistent, albeit slightly lower, than ratios of 9:1 reported in two Asian cohorts [13, 16]. Our univariate analysis identified height, weight, BMI, size of pneumothorax, and treatment modality as significant prognostic factors, which is consistent with other studies in European and Asian cohorts [11, 13, 17].…”

Section: Discussionsupporting

confidence: 91%

Association Between BMI and Recurrence of Primary Spontaneous Pneumothorax

et al. 2016

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BackgroundWhether body mass index (BMI) is a significant risk factor for recurrence of primary spontaneous pneumothorax (PSP) remains controversial. The purpose of this study was to examine whether BMI and other factors are linked to risk of PSP recurrence.MethodsA consecutive cohort of 273 patients was retrospectively evaluated. Patients were divided into those who experienced recurrence (n = 81) and those who did not (n = 192), as well as into those who had low BMI (n = 75) and those who had normal or elevated BMI (n = 198). The two pairs of groups were compared in terms of baseline data, and Cox proportional hazards modeling was used to identify predictors of PSP recurrence.ResultsRates of recurrence among all 273 patients were 20.9% at 1 year, 23.8% at 2 years, and 28.7% at 5 years. Univariate analysis identified the following significant predictors of PSP recurrence: height, weight, BMI, size of pneumothorax, and treatment modality. Multivariate analyses identified several risk factors for PSP recurrence: low BMI, pneumothorax size ≥50%, and non-surgical treatment. Kaplan–Meier survival analysis indicated that patients with low BMI showed significantly lower recurrence-free survival than patients with normal or elevated BMI (P < 0.001).ConclusionsLow BMI, pneumothorax size ≥50%, and non-surgical treatment were risk factors for PSP recurrence in our cohort. Low BMI may be a clinically useful predictor of PSP recurrence.

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“…Meanwhile, many studies tried to find risk factors related to PoR of PSP in terms of demographic variables (age, gender, and smoking) [ 2 , 15 , 16 ], pneumothorax history (large size of the first episode) [ 17 ], radiological findings (presence of a bleb or bullae on CT and diaphragmatic tenting) [ 18 , 19 ], and surgical techniques (mechanical or chemical pleurodesis, vicryl mesh, and PGA coverage) [ 2 , 4 , 7 ]. Recently, several meta-analyses reported the benefits of PGA coverage [ 20 ] and mechanical and chemical pleurodesis [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

Woo

Kim

et al. 2021

JCM

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Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to suggest a possible way to differentiate recurrence events based on temporal patterns. Methods: This single-center study retrospectively evaluated all postoperative recurrence of PSP from January 2007 to May 2019. Patients’ demographics, history of pneumothorax, radiologic data, surgical technique, and the time between operation and recurrence were analyzed. Univariate and multivariable analyses were conducted to find potential risk factors related to long-term recurrence. Results: Of the 77 postoperative recurrent cases of pneumothorax, 21 (27.2%) occurred within 30 days after surgery and, thus, were classified as early recurrences (ER), while the remaining cases were classified as late recurrences (LR). There was no difference in preoperative variables between the two groups. However, the rate of incidence of second recurrence (SR), which represented a long-term prognosis, was significantly higher in the LR group (28.6% vs. 4.8%, p = 0.030). On univariate and multivariable analyses, late recurrence was the only significant factor predicting later recurrence events. Conclusion: Postoperative recurrence (PoR) within 30 days had a lower SR rate. Therefore, it might not be a ‘true’ postoperative recurrence with a favorable prognosis. Further studies investigating postoperative recurrence based on temporal patterns would be warranted to improve the classification of PoR.

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What Factors Predict Recurrence after an Initial Episode of Primary Spontaneous Pneumothorax in Children?

Cited by 39 publications

References 26 publications

Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation

Changing the Paradigm for Management of Pediatric Primary Spontaneous Pneumothorax: A Simple Aspiration Test Predicts Need for Operation

Association Between BMI and Recurrence of Primary Spontaneous Pneumothorax

Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence

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