title: Surgical indications for spontaneous pneumothorax in patients over 50 years of age.
abstract: 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.
authors.affiliation: Department of Surgery, Osaka City Kita Hospital, Japan. m1364552@msic.med.osaka-cu.ac.jp
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Nishiyama
authors.forename: Kohshi
authors.initials: K
authors.lastname: Nagano
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishida
authors.forename: Kiyotoshi
authors.initials: K
authors.lastname: Inoue
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
mesh_terms: 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
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen