title: Factors associated with proceeding to surgical intervention and recurrence of primary spontaneous pneumothorax in adolescent patients.
abstract: Primary spontaneous pneumothorax (PSP) is not uncommon, and its recurrence is often a challenging clinical problem. Surgical management and predisposing factors for the recurrence of PSP, however, have not yet been well elucidated in adolescent patients. The major aim of this study was to investigate factors associated with proceeding to surgical intervention and recurrence of PSP in adolescents. Two hundred and nineteen episodes of PSP in 171 adolescent patients were retrospectively reviewed. The clinical and radiological spectrum of PSP and factors for proceeding to surgical intervention were assessed in these 171 patients. Risk factors for the recurrence of PSP were further analyzed in 128 patients with first attack of PSP. The male-to-female ratio of the 171 PSP patients was 9:1, and the mean age was 17.6 ± 1.5 years. The median body mass index (BMI) percentile was 11 (range 2-31), and 45 (34 %) patients had underweight BMI. The incidence of recurrent PSP was high with a total recurrence rate of 21 %. Ipsilateral recurrence rate of PSP after video-assisted thoracoscopic surgery (VATS) was much less than that of the conservative treatment (4 vs. 18 %). A large-size pneumothorax with a persistent air leak was the most significant factor for proceeding to VATS surgery (P = 0.001). In addition, it was a significant factor influencing the recurrence of PSP (P = 0.014). Other factors that did not significantly affect the recurrence rate were BMI, smoking status, and the number of bullae.
  
  
  CONCLUSIONS
  Adolescent PSP has a high recurrence rate of 21 % after a 2-year follow-up. A large-size pneumothorax with a persistent air leak may not only lead to surgical intervention but also the risk of a recurrence of PSP. The initial size of pneumothorax may not only guide the management process but also predict the risk of a recurrence in adolescent patients with PSP.
authors.affiliation: Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan, pedchestic@gmail.com.
authors.forename: Chih-Yung
authors.initials: CY
authors.lastname: Chiu
authors.forename: Tzu-Ping
authors.initials: TP
authors.lastname: Chen
authors.forename: Chia-Jung
authors.initials: CJ
authors.lastname: Wang
authors.forename: Ming-Han
authors.initials: MH
authors.lastname: Tsai
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome