Surgical indications for spontaneous pneumothorax in patients over 50 years of age.
BACKGROUND
Surgery is often required in cases of spontaneous pneumothorax. This situation can pose considerable difficulty with correct preoperative estimate of pulmonary function. Simple indications for surgery are mandatory, especially in aged patients.


METHODS
To examine the indications and safety of surgery in patients over 50 years, 23 operations in 22 patients over a 6-year period from 1998 to 2003 were reviewed retrospectively. All 23 cases had a grade 2 or better performance status. In all cases, operations were performed with bullectomy or pneumonorrhaphy by a limited thoracotomy with videothoracoscopy in 5 cases.


RESULTS
All patients recovered to the same performance status as before the onset of the pneumothoraces, with the exception of one who died, and changes between pre- and postoperative arterial oxygen or carbon dioxide tension were not significant. Lung-related postoperative complications, including 1 mortality (4%), occurred in three cases who required emergency operation because of massive air leaks with incomplete lung reexpansion, obvious mediastinal emphysema or severe subcutaneous emphysema.


CONCLUSIONS
Surgical interventions may be safely performed when the patient's performance status is grade 2 or better, but care must be taken to avoid postoperative complications in preoperative conditions as massive air leaks with incomplete lung reexpansion, obvious mediastinal emphysema or severe subcutaneous emphysema.
Nishiyama
Noritoshi
N
Department of Surgery, Osaka City Kita Hospital, Japan. m1364552@msic.med.osaka-cu.ac.jp
Nagano
Kohshi
K
Nishida
Tatsuya
T
Inoue
Kiyotoshi
K
Suehiro
Shigefumi
S
D000367:Age Factors; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D015505:Chest Tubes; D006801:Humans; D008168:Lung / Q000503:physiopathology; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011030:Pneumothorax / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000150:complications* / Q000503:physiopathology; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D002245:Carbon Dioxide; D010100:Oxygen