Surgery is Avoidable in Many Pneumothorax Cases

A new study suggests that conservative management of primary spontaneous pneumothorax may be better than surgical intervention, with a lower risk of serious adverse events.

Researchers at Royal Perth Hospital (RPH; Australia), the University of Western Australia (UWA; Crawley, Australia), the Medical Research Institute of New Zealand (MRINZ; Wellington, New Zealand), and other institutions conducted a multi-center study in 316 patients with unilateral, moderate-to-large, primary spontaneous pneumothorax. Patients were randomized to surgical intervention with a drainage tube (154 patients) or conservative-management (162 patients). The primary outcome was lung re-expansion within eight weeks.

The results showed that re-expansion within eight weeks occurred in 98.5% of patients that underwent interventional management, and in 94.4% of those who underwent conservative management. The risk for complications was lower in the conservative management group than in the surgical intervention group, and recurrence of pneumothorax was more frequent in the intervention group (16.8%) than in the conservative-management group (8.8%). Conservative management also resulted in a lower risk of serious adverse events. The study was published on January 29, 2020, in the New England Journal of Medicine (NEJM).

“Patients without tubes spent much less time in hospital and had fewer complications; on average, the tube patients spent six days in hospital, while the non-tube patients spent 1.6 days,” said study co-author Kyle Perrin, PhD, of the MRINZ. “The patients were able to go home and get on with their lives immediately rather than stick around in hospital. But the obvious other outcome is the significant cost savings to the health system.”

Primary spontaneous pneumothorax is an abnormal accumulation of air in the pleural space that can result in the partial or complete collapse of a lung. It is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space, creating pressure that is manifest as chest pain on the side of the collapsed lung and shortness of breath. Often, people who experience a primary spontaneous pneumothorax have no prior sign of illness; the blebs themselves typically do not cause any symptoms and are visible only on medical imaging. Affected individuals may have one to more than thirty blebs.

Related Links:
Royal Perth Hospital
University of Western Australia
Medical Research Institute of New Zealand