Surg Today DOI 10.1007/s00595-017-1585-8
ORIGINAL ARTICLE
The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax Yoshitaro Saito1 · Yohei Suzuki1 · Ryo Demura1 · Hideki Kawai1
Received: 21 June 2017 / Accepted: 18 August 2017 © Springer Japan KK 2017
Abstract Purpose Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. Methods We retrospectively examined 61 patients with SSP, and evaluated the patients’ characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. Results There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38–21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44–31.06). Conclusions Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization. * Yoshitaro Saito [email protected] 1
Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222‑1, Kamikitatesaruta, Akita, Akita 010‑1495, Japan
Keywords Secondary spontaneous pneumothorax · Recurrence · Extended hospitalization
Introduction Pneumothorax is classified as primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP). Although PSP is particularly common among young people without underlying disease, SSP frequently occurs in association with primary diseases, such as chronic obstructive pulmonary disease (COPD), interstitial pneumonia (IP), and pulmonary fibrosis disease (PFD). Treatment of spontaneous pneumothorax depends on the patient’s condition and can range from conservative treatment, including restorative treatment, drainage, pleurodesis, and transbronchial treatment, to surgical treatment. Most cases of PSP improve with treatment and are unlikely to experience recurrence. SSP, however, is known to be resistant to treatment due to the influence of primary disease and the patient’s poor health in general. As such, the recurrence rate of SSP is high and is associated with extended hospitalization. Therefore, it is imperative to determine the risk factors for recurrence and extended hospitalization of patients with SSP. In this study, we evaluated the background of patients with secondary pneumothorax and the risk factors associated with recurrence and prolonged hospitalization.
Methods This retrospective study was conducted with the approval of the Human Ethics Committee of Akita Red Cross Hospital, Akita, Japan (No. 28-9). From April 2007 to March 2016, 61 patients who underwent hospitalization for the diagnosis
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Surg Today
of secondary pneumothorax, excluding traumatic and iatrogenic pneumothorax, were reviewed retrospectively. We evaluated the patient characteristics, the affected side, primary disease (COPD, IP, PFD, massive pulmonary emphysema, positive pressure ventilation due to neuromuscular disease, lung cancer, pulmonary infection), introduction of home oxygen therapy (HOT), and smoking history (Brinkman index). COPD, IP, and PFD were diagnosed according to the Japanese guideline prepared by the Japan Respiratory Society [1–3]. Advanced pulmonary emphysema was presumed based on the finding of a computed tomography slice with a Goddard score of ≥3 [1, 4]. With regard to the X-ray radiographs at the time of SSP on first admission, we defined the extent of pulmonary collapse as slight, moderate and severe according to the Japan Society for Pneumothorax and Cystic Lung Diseases guidelines. Slight pulmonary collapse was defined as the apex of the lung being on the collarbone on X-ray. Severe collapse of the lung was defined as complete collapse by X-ray. Other cases in between were defined as moderate collapse. Furthermore, the presence of mediastinal shift and adhesion between the lung and chest wall were evaluated by X-ray examination at the time of first visit. We also evaluated treatment with pleurodesis and surgery. The average duration of chest tube insertion, hospital stay, and recurrence of pneumothorax were assessed. The chest tube insertion period and duration of hospitalization were determined for each case. Statistical analyses were performed using the JMP IN 10.0.2 software program (SAS Institute, Cary, NC, USA).
Table 1 Patient characteristics
Number of patients Sex, n (%) Male Female Age (years) Median Range Side, n (%) Right Left Bilateral Primary disease, n (%) COPD IP Massive emphysema Pulmonary fibrosis Neuromuscular disease Lung malignant tumor Pneumonia
Pearson’s Chi squared or Fisher’s exact 2-tailed tests were used for the analysis of categorical data, while continuous variables were analyzed using Student’s t test. To evaluate the risk factors associated with recurrence and prolonged hospitalization (more than 15 days longer than the average hospital stay in our department), a multiple logistic regression analysis was conducted. The variables chosen for multivariable analysis were primary diseases, including COPD, IP, massive emphysema, and other diseases; X-ray findings showing the presence of moderate or more lung collapse; mediastinal shift and adhesion between the lung and chest wall; the introduction of HOT before hospitalization; and a Brinkman Index over 600. p values
ORIGINAL ARTICLE
The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax Yoshitaro Saito1 · Yohei Suzuki1 · Ryo Demura1 · Hideki Kawai1
Received: 21 June 2017 / Accepted: 18 August 2017 © Springer Japan KK 2017
Abstract Purpose Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. Methods We retrospectively examined 61 patients with SSP, and evaluated the patients’ characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. Results There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38–21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44–31.06). Conclusions Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization. * Yoshitaro Saito [email protected] 1
Department of Thoracic Surgery, Akita Red Cross Hospital, Azainasirosawa222‑1, Kamikitatesaruta, Akita, Akita 010‑1495, Japan
Keywords Secondary spontaneous pneumothorax · Recurrence · Extended hospitalization
Introduction Pneumothorax is classified as primary spontaneous pneumothorax (PSP) or secondary spontaneous pneumothorax (SSP). Although PSP is particularly common among young people without underlying disease, SSP frequently occurs in association with primary diseases, such as chronic obstructive pulmonary disease (COPD), interstitial pneumonia (IP), and pulmonary fibrosis disease (PFD). Treatment of spontaneous pneumothorax depends on the patient’s condition and can range from conservative treatment, including restorative treatment, drainage, pleurodesis, and transbronchial treatment, to surgical treatment. Most cases of PSP improve with treatment and are unlikely to experience recurrence. SSP, however, is known to be resistant to treatment due to the influence of primary disease and the patient’s poor health in general. As such, the recurrence rate of SSP is high and is associated with extended hospitalization. Therefore, it is imperative to determine the risk factors for recurrence and extended hospitalization of patients with SSP. In this study, we evaluated the background of patients with secondary pneumothorax and the risk factors associated with recurrence and prolonged hospitalization.
Methods This retrospective study was conducted with the approval of the Human Ethics Committee of Akita Red Cross Hospital, Akita, Japan (No. 28-9). From April 2007 to March 2016, 61 patients who underwent hospitalization for the diagnosis
13
Vol.:(0123456789)
Surg Today
of secondary pneumothorax, excluding traumatic and iatrogenic pneumothorax, were reviewed retrospectively. We evaluated the patient characteristics, the affected side, primary disease (COPD, IP, PFD, massive pulmonary emphysema, positive pressure ventilation due to neuromuscular disease, lung cancer, pulmonary infection), introduction of home oxygen therapy (HOT), and smoking history (Brinkman index). COPD, IP, and PFD were diagnosed according to the Japanese guideline prepared by the Japan Respiratory Society [1–3]. Advanced pulmonary emphysema was presumed based on the finding of a computed tomography slice with a Goddard score of ≥3 [1, 4]. With regard to the X-ray radiographs at the time of SSP on first admission, we defined the extent of pulmonary collapse as slight, moderate and severe according to the Japan Society for Pneumothorax and Cystic Lung Diseases guidelines. Slight pulmonary collapse was defined as the apex of the lung being on the collarbone on X-ray. Severe collapse of the lung was defined as complete collapse by X-ray. Other cases in between were defined as moderate collapse. Furthermore, the presence of mediastinal shift and adhesion between the lung and chest wall were evaluated by X-ray examination at the time of first visit. We also evaluated treatment with pleurodesis and surgery. The average duration of chest tube insertion, hospital stay, and recurrence of pneumothorax were assessed. The chest tube insertion period and duration of hospitalization were determined for each case. Statistical analyses were performed using the JMP IN 10.0.2 software program (SAS Institute, Cary, NC, USA).
Table 1 Patient characteristics
Number of patients Sex, n (%) Male Female Age (years) Median Range Side, n (%) Right Left Bilateral Primary disease, n (%) COPD IP Massive emphysema Pulmonary fibrosis Neuromuscular disease Lung malignant tumor Pneumonia
Pearson’s Chi squared or Fisher’s exact 2-tailed tests were used for the analysis of categorical data, while continuous variables were analyzed using Student’s t test. To evaluate the risk factors associated with recurrence and prolonged hospitalization (more than 15 days longer than the average hospital stay in our department), a multiple logistic regression analysis was conducted. The variables chosen for multivariable analysis were primary diseases, including COPD, IP, massive emphysema, and other diseases; X-ray findings showing the presence of moderate or more lung collapse; mediastinal shift and adhesion between the lung and chest wall; the introduction of HOT before hospitalization; and a Brinkman Index over 600. p values
