title: Surgery for secondary spontaneous pneumothorax: risk factors for recurrence and morbidity.
abstract: OBJECTIVE
  Secondary spontaneous pneumothorax (SSP) is more common in elderly patients; it has high rates of recurrence and mortality, even if surgery is performed. There has been little study on the surgical treatment of SSP. Therefore, we analysed the outcomes of surgical treatment of SSP patients, and investigated the risk factors of recurrence and morbidity.
  
  
  METHODS
  We studied 97 consecutive surgical treatments on 94 patients with SSP who had emphysematous changes of lung retrospectively. Emphysematous changes on preoperative computed tomography image were evaluated by the Goddard score, which is a visual scoring system. First, video-assisted thoracoscopic surgery was performed, followed by bullectomy for the responsible lesions.
  
  
  RESULTS
  The rate of morbidity was 20.6% and that of mortality was 4.1%. Recurrence rate was 9.3%. By multivariate analysis, a Goddard score≥7 (odds ratio: 8.93, P=0.033) and treatment of bulla without the use of staplers (odds ratio: 11.57, P=0.019) were significant risk factors for morbidity, while pulmonary fibrosis tended to increase the risk of recurrence (hazard ratio: 4.21, P=0.051), and a Goddard score≥7 (hazard ratio: 7.79, P=0.023) was a significant risk factor for recurrence.
  
  
  CONCLUSIONS
  Surgical treatment in patients with SSP had favourable results. Treatment in which the base of the bulla cannot be definitely shut off with staplers is associated with increased morbidity. Significant emphysematous change on preoperative computed tomography image and pulmonary fibrosis are predictors of recurrence. Patients with these findings should be investigated in terms of the indications of surgery and additional treatment, not only bullectomy.
authors.affiliation: Division of Thoracic Surgery, Numazu City Hospital, Numazu, Shizuoka, Japan. mi.isaka@scchr.jp
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Isaka
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Asai
authors.forename: Norikazu
authors.initials: N
authors.lastname: Urabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016016:Proportional Hazards Models; D011656:Pulmonary Emphysema / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Chronic obstructive pulmonary disease; Recurrence; Secondary spontaneous pneumothorax; Video-assisted thoracoscopic surgery; risk factor