title: Outpatient management of primary spontaneous pneumothorax: a prospective study.
abstract: We prospectively assessed the safety and cost saving of a small-bore drain based procedure for outpatient management of first episodes of primary spontaneous pneumothorax. Patients were managed by observation alone or insertion of an 8.5-F "pig-tail" drain connected to a one-way valve, according to size and clinical tolerance of the pneumothorax. All patients were reassessed after 4 h, on the first working day after discharge and on day 7. Patients still exhibiting air leak on day 4 underwent thoracoscopy. The primary end-point was complete lung re-expansion at day 7. 60 consecutive patients entered the study. 48 (80%) met the definition of large pneumothorax. The success rate was 83%. The 1-year recurrence rate was 17%. 36 (60%) patients were discharged after 4 h and 50% had full outpatient management. No severe complication was observed. The mean ± SD length of hospitalisation was 2.3 ± 3.1 days. This policy resulted in about a 40% reduction in hospital stay-related costs. The present study supports the use of a single system combined with a well-defined management algorithm including safe discharge criteria, as an alternative to manual aspiration or chest tube drainage. This approach participates in healthcare cost-savings.
authors.affiliation: Lille.
authors.forename: Massongo
authors.initials: M
authors.lastname: Massongo
authors.forename: Sylvie
authors.initials: S
authors.lastname: Leroy
authors.forename: Arnaud
authors.initials: A
authors.lastname: Scherpereel
authors.forename: Fabien
authors.initials: F
authors.lastname: Vaniet
authors.forename: Xavier
authors.initials: X
authors.lastname: Dhalluin
authors.forename: Bachar
authors.initials: B
authors.lastname: Chahine
authors.forename: Céline
authors.initials: C
authors.lastname: Sanfiorenzo
authors.forename: Michaël
authors.initials: M
authors.lastname: Genin
authors.forename: Charles-Hugo
authors.initials: CH
authors.lastname: Marquette
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002404:Catheterization; D015505:Chest Tubes; D004322:Drainage / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010351:Patient Discharge; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult