title: Videothoracoscopy versus thoracotomy for the treatment of spontaneous pneumothorax: a propensity score analysis.
abstract: BACKGROUND
  Few randomized controlled trials have been published on outcomes after treatment of spontaneous pneumothorax. The objective of this study was to assess recurrence, pulmonary complications, prolonged air leak, and hospital duration of stay in patients undergoing videothoracoscopic surgery (VATS) or thoracotomy for spontaneous pneumothorax.
  
  
  METHODS
  From January 2005 to December 2012, 7,396 patients underwent operations for spontaneous pneumothorax and were entered into the French national database. The propensity score, which is the conditional probability of assignment to a particular treatment given a vector of observed covariates, was used for the analysis. Three statistical analyses were performed: matching, subclassification, and the inverse probability of treatment weighting. The primary end point was recurrence, defined as a pneumothorax requiring a chest tube or new operation. The secondary end point was pulmonary complications, prolonged air leak, and hospital duration of stay.
  
  
  RESULTS
  VATS was performed in 6,419 patients and thoracotomy in 997 patients. Pleurodesis was performed by abrasion or pleurectomy in 5,873 patients (79%) and by using a chemical agent in 1,523 patients (21%). The median time to recurrence was 3 months (range, 1 to 76 months). The recurrence rate was higher in the VATS group regardless of the statistical analysis that was used: 2.1 for unmatched samples, 2.5 for matched samples, 2.3 for subclassification, and 1.7 for the inverse probability of treatment weighting. VATS significantly reduced the hospital duration of stay by 1 day but did not significantly reduce pulmonary complications or prolonged air leak.
  
  
  CONCLUSIONS
  VATS reduced the hospital duration of stay, but the risk of recurrence was higher. This information should be delivered to patients before pneumothorax operations.
authors.affiliation: Centre Hospitalier Universitaire Dijon, Bocage Hospital, Dijon, France. Electronic address: pierrebenoit.pages@chu-dijon.fr.
authors.forename: Pierre-Benoit
authors.initials: PB
authors.lastname: Pagès
authors.affiliation: Centre Hospitalier Universitaire Dijon, Bocage Hospital, Dijon, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Delpy
authors.affiliation: Centre Hospitalier Universitaire Strasbourg, Civil Hospital, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Centre Hospitalier Universitaire Marseille, North Hospital, Marseille, France.
authors.forename: Pascal-Alexandre
authors.initials: PA
authors.lastname: Thomas
authors.affiliation: Centre Hospitalier Universitaire Clermont-Ferrand, Centre Jean Perrin Hospital, Clermont-Ferrand, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Filaire
authors.affiliation: Georges Pompidou European Hospital, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec Barthes
authors.affiliation: Centre Hospitalier Universitaire Toulouse, Larrey Hospital, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Centre Hospitalier Universitaire Dijon, Bocage Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000601:surgery*; D057216:Propensity Score; D012008:Recurrence; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy