A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax.
BACKGROUND
Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric PSP.


METHODS
We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June 30, 1996.


RESULTS
Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 +/- 1.1 years, boy-girl ratio 4:1, median body mass index 18 (normal, 20-25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14 with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000. In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a single recurrence would be $230,000.


CONCLUSIONS
A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation, followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax.
Cook
C H
CH
Departments of Surgery, The Ohio State University Hospitals and Columbus Children's Hospitals, N-747 Doan Hall, 410 West Tenth Avenue, Columbus, OH 43210, USA.
Melvin
W S
WS
Groner
J I
JI
Allen
E
E
King
D R
DR
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D004322:Drainage; D017722:Hospital Charges; D006801:Humans; D011030:Pneumothorax / Q000191:economics* / Q000601:surgery* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics*; D013907:Thoracostomy / Q000191:economics