title: Surgical treatment for elderly patients with secondary spontaneous pneumothorax.
abstract: OBJECTIVE
  Our objective was to evaluate the validity of surgery for secondary spontaneous pneumothorax (SSP) by comparison with other treatments or with perioperative results for primary spontaneous pneumothorax (PSP).
  
  
  METHODS
  Between January 2009 and March 2015, 144 patients with SSP, aged 60 years or over, were treated in our institution. We reviewed the patients' characteristics, perioperative results, and relapse rate. Treatment to arrest air-leakage included surgery (n = 79), drainage only (n = 30), and pleurodesis (n = 35), and the pneumothorax relapse rate or mortality before discharge was compared for each. Additionally, we compared the perioperative results or relapse rate between SSP (n = 70) and PSP (n = 70) in patients who underwent 3-port thoracoscopic surgery.
  
  
  RESULTS
  There was a significant difference in the relapse rate between the surgery and non-surgery groups (5.3 vs. 27.4 %, p = 0.0006). However, no significant difference in mortality before discharge was determined (p = 0.66). Significant differences were identified between the SSP and PSP groups for operation time, duration of chest drainage, and the length of postoperative hospitalization, and the postoperative morbidity were greater in the SSP group (p < 0.0001 for all). However, there was no significant difference in postoperative 30-day mortality or the relapse rate (p = 0.5, p = 0.68, respectively).
  
  
  CONCLUSIONS
  Surgical treatment under general anesthesia for SSP is effective for arresting persistent air leaks or avoiding pneumothorax relapse, compared with drainage or pleurodesis, and is feasible if the appropriate perioperative management is performed.
authors.affiliation: Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma, 371-0014, Japan. hitoshi-iga@hotmail.co.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Igai
authors.affiliation: Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamiyoshihara
authors.affiliation: Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ibe
authors.affiliation: Department of General Thoracic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma, 371-0014, Japan.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Kawatani
authors.affiliation: Gunma University Graduate School of Medicine, Maebashi, Japan.
authors.forename: Kimihiro
authors.initials: K
authors.lastname: Shimizu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D018700:Pleurodesis / Q000379:methods; D011030:Pneumothorax / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence; D015203:Reproducibility of Results; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome
keywords: Elderly patients; Secondary spontaneous pneumothorax; Surgical treatment