Size of pneumothorax can be a new indication for surgical treatment in primary spontaneous pneumothorax: a prospective study

Ann Thorac Cardiovasc Surg. 2014;20(3):192-7. doi: 10.5761/atcs.oa.12.02212. Epub 2013 Apr 20.


Purpose: Surgical treatment of primary spontaneous pneumothorax (PSP) is usually performed in cases of prolonged air leak (PAL) or recurrence. We investigated the effect of the size of pneumothorax in surgically treated PSP cases.

Methods: Between 2007 and 2008, 181 patients hospitalized with the diagnosis of PSP were prospectively recorded. The size of pneumothorax was calculated in percentages by the method defined by Kircher and Swartzel. Patients were divided into two groups, according to pneumothorax size: Group A (large pneumothorax, ≥50%), and Group B (small or moderate pneumothorax, <50%).

Results: The mean size of pneumothorax was 80.5 ± 10.4% in Group A (n = 54, 29%) and 39.5 ± 6.5% in Group B (n = 127, 71%). History of smoking and smoking index were significantly higher in Group A patients (p = 0.02, p <0.001, respectively). Fifty-five patients (29.3%) required surgery because of PAL or ipsilateral recurrence. The rate of patients requiring surgical operation was significantly higher in Group A (51.9%) than in Group B (n = 25; p <0.001). Rates of PAL and recurrence were higher in Group A than in Group B (p = 0.007, p = 0.004, respectively).

Conclusion: The size of pneumothorax is larger in those with a smoking history and a higher smoking index. Surgical therapy can be considered in cases with a pneumothorax size ≥50% after the first episode immediately.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Chest Tubes
  • Drainage / instrumentation
  • Female
  • Humans
  • Male
  • Patient Selection
  • Pneumothorax / diagnosis
  • Pneumothorax / etiology
  • Pneumothorax / surgery*
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Smoking / adverse effects
  • Thoracic Surgery, Video-Assisted*
  • Thoracostomy / instrumentation
  • Treatment Outcome
  • Young Adult