Abstract:

Objective

To analyze the surgical outcomes and the recurrence risk of spontaneous pneumothorax in patients.

Methods

All of 71 patients with refractory spontaneous pneumothorax were selected as subjects from January 1，2014 to July 28，2023.Indications for surgery include ipilateral spontaneous pneumothorax ＞2 times，chest gas volume ≥30%，or chronic air leakage difficult to heal.Surgical procedures（minimally invasive video-assisted thoracoscopic surgery or thoracotomy），pleuropexy，or thoracoscopic argon plasma coagulation （APC） were used.Cox regression analysis was used to predict the prognosis of spontaneous pneumothorax.Receiver operating characteristic （ROC） curve，nomogram and calibration curve were used to determine the prediction of spontaneous pneumothorax by Cox regression analysis.

Results

There was no death during or perioperative period.14 cases （19.72%） sustained air leakage ≥2 d.Postoperative complications occurred in 15 cases （21.13%），including severe complications in 9 cases （12.68%）.The median recurrence time was 110.0（17.0～351.0）days，and 12 cases （16.90%） relapsed.Single-factor analysis showed Charlson′s co-morbidity index （CCI），morbidity to surgery，severe thoracic morbidity，hemoglobin （Hb）before surgery，lymphocyte/monocyte ratio and mean length of hospital stay were associated with spontaneous pneumothorax recurrence （P＜0.05）.Cox analysis results showed that preoperative CCI ［HR（95%CI） ： 1.235 （1.057-1.443）］，time from onset to operation ［HR （95%CI） ： 1.041 （1.008-1.076）］ and Hb［HR（95%CI）： 0.976（0.960-0.992）］ was the influential factor of postoperative pneumothorax recurrence （P ＜0.05）.The Cox prediction equation was h（t） ＝0.976×（-0.025×Hb） ＋1.235× （0.211×CCI） ＋1.041× （0.041× time from onset to operation），and the column graph showed that C-index was 0.874 （95%CI： 0.821-0.928），Hb had a significant effect on spontaneous pneumothorax recurrence.Calibration curves showed that there was little deviation in predicting spontaneous pneumothorax recurrence at 3，6 and 12 months after surgery.The ROC curve predicted spontaneous pneumothorax recurrence at 3 months AUC 95%CI： 0.84 （0.74-0.94），6 months AUC 95%CI： 0.90 （0.81-0.99） and 12 months AUC 95%CI： 0.89 （0.76-1.00）.

Conclusion

Low Hb，long time from onset to operation and high CCI are risk factors for postoperative recurrence of refractory spontaneous pneumothorax.

Key words: Spontaneous pneumothorax, Surgery, Refractory, Recurrence