title: Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery†.
abstract: OBJECTIVE
  Over the past two decades, video-assisted thoracoscopic blebectomy and pleurodesis have been used as a safe and reliable option for treatment of spontaneous pneumothorax. The aim of this study is to evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) treatment of spontaneous pneumothorax in young patients, and to identify risk factors for postoperative recurrence.
  
  
  METHODS
  We retrospectively analysed the outcome of VATS treatment of spontaneous pneumothorax in our institution in 150 consecutive young patients (age ≤ 40 years) in the years 1997-2010. Treatment consisted of stapling blebectomy and partial parietal pleurectomy. After excluding 16 patients lost to follow-up, in 134 cases [110 men, 24 women; mean age, 25 ± 7 standard deviation years; median follow-up, 79 months (range: 36-187 months)], we evaluated postoperative complications, focusing on pneumothorax recurrence, thoracic dysaesthesia and chronic chest pain. Risk factors for postoperative pneumothorax recurrence were analysed by logistic regression.
  
  
  RESULTS
  Of 134 treated patients, 3 (2.2%) required early reoperation (2 for bleeding; 1 for persistent air leaks). Postoperative (90-day) mortality was nil. Ipsilateral pneumothorax recurred in 8 cases (6.0%) [median time of recurrence, 43 months (range: 1-71 months)]. At univariate analysis, the recurrence rate was significantly higher in women (4/24) than in men (4/110; P = 0.026) and in patients with >7-day postoperative air leaks (P = 0.021). Multivariate analysis confirmed that pneumothorax recurrence correlated independently with prolonged air leaks (P = 0.037) and with female gender (P = 0.045). Chronic chest wall dysaesthesia was reported by 13 patients (9.7%). In 3 patients, (2.2%) chronic thoracic pain (analogical score >4) was recorded, but only 1 patient required analgesics more than once a month.
  
  
  CONCLUSIONS
  VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long-term recurrence rate in our experience. Postoperative recurrence significantly correlates with female gender and with prolonged air leakage after surgery.
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy andrea.imperatori@uninsubria.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Imperatori
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rotolo
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Spagnoletti
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Festi
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Berizzi
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Di Natale
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Nardecchia
authors.affiliation: Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Dominioni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Blebectomy; Partial parietal pleurectomy; Postoperative recurrence; Risk factors; Spontaneous pneumothorax; Video-assisted thoracoscopic surgery