SPONTANEOUS PNEUMOTHORAX - DETERMINANTS OF SURGICAL INTERVENTION

Objective. To assess the long term efficacy of intercostal tube draina ge for spontaneous pneumothorax and determine the clinical parameters associated with surgery, Experimental design, Retrospective analysis w ith a mean follow-up of 62.3+/-19.3 months (range 23 to 94 months), Se tting, Riyadh Medical Complex, Riyadh (Saudi Arabia), the biggest refe rral centres for Ministry of Health providing specialized hospital car e, Patients. Over a period of six year, 123 patients had 182 episodes of spontaneous pneumothorax, Male to female ratio was 29.75:1 (p=0.000 01), Average age was 26.35+/-8.33 years for men and 37.25+/-14.6 years for women (p=0.01). Seventy eight per cent of patients were aged 11 t o 30 years (p=0.00001), Majority were nonsmokers (100/123, p=0.00001), It was first episode of spontaneous pneumothorax for 86 patients, Oth er 37 patients had 57 episodes previously (mean 1.54+/-0.73; range 1 t o 4). Interventions. Intercostal tube drainage for all patient with sp ontaneous pneumothorax. Limited axillary thoracotomy with bullectomy a nd pleuroabrasion for 32 patients not responding to intercostal tube d rainage, Results. Intercostal tube drainage alone had success rate of 90.7% in first, 52.4% in second, 15.4% in third and 0% for more than 3 episodes of spontaneous pneumothorax. Among the 32 patients who under went surgery, only one had early recurrence that did not require drain age, We found that patients with history of recurrence, respiratory di stress and those requiring tube thoracostomy for more than 4 days and negative suction to expand the lung were more liable to undergo surgic al intervention (p=0.00001 for all variables). Conclusions. We recomme nd early surgery to hasten recovery and shorten the hospital stay in p atients with history of recurrent spontaneous pneumothorax, respirator y distress and those requiring tube thoracostomy for more than 4 days and negative suction to expand the lung.