SPONTANEOUS PRIMARY AND SECONDARY PNEUMOTHORAX - A 10-YEAR STUDY OF MANAGEMENT ALTERNATIVES

Objective. To study the outcome of conservative and surgical managemen t of spontaneous pneumothorax. Design: Retrospectiye study between Jan uary 1980 and December 1990, with a mean follow-up of 6.5 years. Setti ng: A tertiary-care university hospital with a referral thoracic surgi cal unit. Patients. AlI patients seen in the study period with spontan eous pneumothorax. Those with traumatic, iatrogenic or ventilator-asso ciated pneumothoraces were excluded. There were 366 consecutive patien ts who had 508 episodes of spontaneous pneumothorax. Two hundred and t hirty-nine patients had primary spontaneous pneumothorax (group 1); 12 7 had secondary spontaneous pneumothorax (group 2). Interventions: Tub e thoracostomy, apical resection with either pleurectomy or pleural ab rasion. Main Outcome Measures: Recurrence and outcome after surgical m anagement relative to recurrence, complications, operative technique a nd mean hospital stay were evaluated by clinical review and questionna ire by an independent observer. Results. No significant differences we re noted between the two groups with respect to the incidence of recur rent spontaneous pneumothorax after the first or second episode, and n o significant differences were noted between the two operative techniq ues with respect to recurrence, complications, operative technique or death rate. However the mean hospital stay was doubled for group 2 pat ients (9.9 versus 4.3 days). Conclusions: Conservative treatment, incl uding tube thoracostomy, was effective for primary and secondary spont aneous pneumothorax. Open surgery was effective in preventing recurren ce in 95% of cases in both groups.