title: The Size of Spontaneous Pneumothorax is a Predictor of Unsuccessful Catheter Drainage.
abstract: Small-bore thoracic catheter drainage is recommended for a first large or symptomatic episode of primary spontaneous pneumothorax (PSP). However, one-third of these patients require a second procedure because of treatment failure. We investigated the factors associated with unsuccessful pigtail catheter drainage in the management of PSP. In this retrospective study, using a prospectively collected database, we enrolled 253 consecutive patients with PSP who underwent pigtail catheter drainage as initial treatment, from December 2006 to June 2011. The chest radiograph was reviewed in each case and pneumothorax size was estimated according to Light's index. Other demographic factors and laboratory data were collected via chart review. Pigtail catheter drainage was successful in 71.9% (182/253) of cases. Treatment failure rates were 42.9%, 25.9%, and 15.5% in patients with pneumothorax sizes of >62.6%, 38-62.6%, and <38%, respectively (tertiles). An alternative cut-off point of 92.5% lung collapse was defined using a classification and regression tree method. According to the multivariate analysis, a large-size pneumothorax (p = 0.009) was the only significant predictor of initial pigtail catheter drainage treatment failure in patients with PSP. Early surgical treatment could be considered for those patients with a large-sized pneumothorax.
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.
authors.forename: Tung-Ming
authors.initials: TM
authors.lastname: Tsai
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan.
authors.forename: Mong-Wei
authors.initials: MW
authors.lastname: Lin
authors.affiliation: Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, 10055, Taiwan.|Genomic Research Center, Academia Sinica, Taipei, 11529, Taiwan.
authors.forename: Yao-Jen
authors.initials: YJ
authors.lastname: Li
authors.affiliation: Department of Medical Research, National Taiwan University Hospital, Taipei, 10002, Taiwan.
authors.forename: Chin-Hao
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Traumatology, National Taiwan University Hospital, Taipei, 10002, Taiwan.
authors.forename: Hsien-Chi
authors.initials: HC
authors.lastname: Liao
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 22060, Taiwan.
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan. ntuhsu@gmail.com.
authors.forename: Hsao-Hsun
authors.initials: HH
authors.lastname: Hsu
authors.affiliation: Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan. chenjs@ntu.edu.tw.|Department of Traumatology, National Taiwan University Hospital, Taipei, 10002, Taiwan. chenjs@ntu.edu.tw.
authors.forename: Jin-Shing
authors.initials: JS
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D057785:Catheters; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult