title: Size of pneumothorax can be a new indication for surgical treatment in primary spontaneous pneumothorax: a prospective study.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Yedikule Thoracic Surgery and Chest Disease Traning and Research Hospital.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sayar
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Kök
authors.forename: Necati
authors.initials: N
authors.lastname: Citak
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Metin
authors.forename: Songül
authors.initials: S
authors.lastname: Büyükkale
authors.forename: Atilla
authors.initials: A
authors.lastname: Gürses
mesh_terms: D000328:Adult; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted; D013907:Thoracostomy / Q000295:instrumentation; D016896:Treatment Outcome; D055815:Young Adult