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Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients.

Abstract

OBJECTIVES

There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients.

METHODS

Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien-Dindo classification) were analysed for efficacy and safety assessment, respectively.

RESULTS

Median postoperative air leaks continued for 0 days (range 0-25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00-1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38-27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%.

CONCLUSIONS

Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively.

Authors+Show Affiliations

Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.Department of Thoracic Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31603211

Citation

Nagata, Shunichi, et al. "Efficacy and Safety of Surgery for Spontaneous Pneumothorax in Elderly Patients." Interactive Cardiovascular and Thoracic Surgery, 2019.
Nagata S, Omasa M, Tokushige K, et al. Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients. Interact Cardiovasc Thorac Surg. 2019.
Nagata, S., Omasa, M., Tokushige, K., Nakanishi, T., & Motoyama, H. (2019). Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients. Interactive Cardiovascular and Thoracic Surgery, doi:10.1093/icvts/ivz252.
Nagata S, et al. Efficacy and Safety of Surgery for Spontaneous Pneumothorax in Elderly Patients. Interact Cardiovasc Thorac Surg. 2019 Oct 11; PubMed PMID: 31603211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients. AU - Nagata,Shunichi, AU - Omasa,Mitsugu, AU - Tokushige,Kosuke, AU - Nakanishi,Takao, AU - Motoyama,Hideki, Y1 - 2019/10/11/ PY - 2019/08/07/received PY - 2019/09/07/revised PY - 2019/09/19/accepted PY - 2019/10/12/entrez KW - Efficacy and safety KW - Elderly patients KW - Performance status KW - Risk factor KW - Secondary spontaneous pneumothorax KW - Spontaneous pneumothorax JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg N2 - OBJECTIVES: There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients. METHODS: Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien-Dindo classification) were analysed for efficacy and safety assessment, respectively. RESULTS: Median postoperative air leaks continued for 0 days (range 0-25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00-1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38-27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%. CONCLUSIONS: Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/31603211/Efficacy_and_safety_of_surgery_for_spontaneous_pneumothorax_in_elderly_patients L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivz252 DB - PRIME DP - Unbound Medicine ER -