Primary vs delayed surgery for spontaneous pneumothorax in children: Which is better?

Faisal G. Qureshi, Vlad C. Sandulache, Ward Richardson, Orkan Ergun, Henri R. Ford, David Hackam

Research output: Contribution to journalArticle

Abstract

Controversy exists regarding the timing of surgery for spontaneous pneumothorax (SP), which can be performed either after the first development of pneumothorax or after a recurrent spontaneous pneumothorax has occurred. Treatment after recurrence is often adopted because of the purported low recurrence of SP treated nonoperatively and the historical morbidity of open surgery. However, the effectiveness of VATS (to video-assisted bullectomy and pleurodesis) has raised the possibility of performing primary VATS (PV) in all patients. The authors therefore hypothesized that PV is safe and effective for SP and sought to perform a cost-benefit analysis of PV vs secondary VATS (SV). After institutional review board approval, consecutive patients with SP (1991-2003) and no comorbidities were retrospectively divided into PV vs SV. Demographics, recurrent pneumothorax after VATS, length of stay, and costs were compared by Student's t test/χ2. The predicted incremental cost of PV was (cost of PV) - {[cost of nonoperative treatment × (1 - recurrence rate)] + cost of SV × recurrence rate}. Data are means ± SEM. There were 54 spontaneous pneumothoraces in 43 patients (11 bilateral), of whom 3 were excluded because of open thoracotomy. Of 51 pneumothoraces, nonoperative treatment was attempted in 37, of whom 20 recurred and thus required SV. Primary VATS was performed in 14. Both groups had similar age, sex, weight, height, admission heart rate, and room air oxygen saturation. Total treatment length of stay was significantly shorter for PV vs SV (7.1 ± 0.96 vs 10.5 ± 1.2, P =. 04). However, morbidity from recurrent pneumothorax after VATS occurred more frequently after PV than SV (4/14 vs 0/20 P

Original languageEnglish (US)
Pages (from-to)166-169
Number of pages4
JournalJournal of Pediatric Surgery
Volume40
Issue number1
DOIs
StatePublished - Jan 2005
Externally publishedYes

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Video-Assisted Thoracic Surgery
Pneumothorax
Costs and Cost Analysis
Recurrence
Length of Stay
Pleurodesis
Morbidity

Keywords

  • Bleb
  • Pediatric surgery
  • Pleurodesis
  • Thoracotomy
  • VATS blebectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Primary vs delayed surgery for spontaneous pneumothorax in children : Which is better? / Qureshi, Faisal G.; Sandulache, Vlad C.; Richardson, Ward; Ergun, Orkan; Ford, Henri R.; Hackam, David.

In: Journal of Pediatric Surgery, Vol. 40, No. 1, 01.2005, p. 166-169.

Research output: Contribution to journalArticle

Qureshi, Faisal G. ; Sandulache, Vlad C. ; Richardson, Ward ; Ergun, Orkan ; Ford, Henri R. ; Hackam, David. / Primary vs delayed surgery for spontaneous pneumothorax in children : Which is better?. In: Journal of Pediatric Surgery. 2005 ; Vol. 40, No. 1. pp. 166-169.
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abstract = "Controversy exists regarding the timing of surgery for spontaneous pneumothorax (SP), which can be performed either after the first development of pneumothorax or after a recurrent spontaneous pneumothorax has occurred. Treatment after recurrence is often adopted because of the purported low recurrence of SP treated nonoperatively and the historical morbidity of open surgery. However, the effectiveness of VATS (to video-assisted bullectomy and pleurodesis) has raised the possibility of performing primary VATS (PV) in all patients. The authors therefore hypothesized that PV is safe and effective for SP and sought to perform a cost-benefit analysis of PV vs secondary VATS (SV). After institutional review board approval, consecutive patients with SP (1991-2003) and no comorbidities were retrospectively divided into PV vs SV. Demographics, recurrent pneumothorax after VATS, length of stay, and costs were compared by Student's t test/χ2. The predicted incremental cost of PV was (cost of PV) - {[cost of nonoperative treatment × (1 - recurrence rate)] + cost of SV × recurrence rate}. Data are means ± SEM. There were 54 spontaneous pneumothoraces in 43 patients (11 bilateral), of whom 3 were excluded because of open thoracotomy. Of 51 pneumothoraces, nonoperative treatment was attempted in 37, of whom 20 recurred and thus required SV. Primary VATS was performed in 14. Both groups had similar age, sex, weight, height, admission heart rate, and room air oxygen saturation. Total treatment length of stay was significantly shorter for PV vs SV (7.1 ± 0.96 vs 10.5 ± 1.2, P =. 04). However, morbidity from recurrent pneumothorax after VATS occurred more frequently after PV than SV (4/14 vs 0/20 P",
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