PDF(Pubmed)
Abstract：
OBJECTIVE: The optimal surgical strategy for primary spontaneous pneumothorax remains a matter of debate and variation in surgical practice is expected. This variation may influence clinical outcomes, such as postoperative complications and length of stay. This national population-based registry study provides an overview and extent of variability of current surgical practice and outcomes in the Netherlands.
METHODS: To identify national patterns of care and between-hospital variability in the treatment of primary spontaneous pneumothorax, patients who underwent surgical pleurodesis and/or bullectomy between 2014 and 2021, were identified from the Dutch Lung Cancer Audit-Surgery database. The type of surgical intervention, postoperative complications, length of stay and ipsilateral recurrences were recorded.
CONCLUSIONS: Out of 4338 patients, 1851 patients were identified to have primary spontaneous pneumothorax. The median age was 25 years (interquartile range 20-31) and 82% was male. The most performed surgical procedure was bullectomy with pleurodesis (83%). The overall complication rate was 12% (Clavien-Dindo grade ≥III 6%), with the highest recorded incidence for persistent air leak >5 days (5%). Median postoperative length of stay was 4 days (interquartile range 3-6) and 0.7% underwent a repeat pleurodesis for ipsilateral recurrence. Complication rate and length of stay differed considerably between hospitals. There were no differences between the surgical procedures. In the Netherlands, surgical patients with primary spontaneous pneumothorax are preferably treated with bullectomy plus pleurodesis. Postoperative complications and length of stay vary widely and are considerable in this young patient group. This may be reduced by optimization of surgical care.
METHODS: To identify national patterns of care and between-hospital variability in the treatment of primary spontaneous pneumothorax, patients who underwent surgical pleurodesis and/or bullectomy between 2014 and 2021, were identified from the Dutch Lung Cancer Audit-Surgery database. The type of surgical intervention, postoperative complications, length of stay and ipsilateral recurrences were recorded.
CONCLUSIONS: Out of 4338 patients, 1851 patients were identified to have primary spontaneous pneumothorax. The median age was 25 years (interquartile range 20-31) and 82% was male. The most performed surgical procedure was bullectomy with pleurodesis (83%). The overall complication rate was 12% (Clavien-Dindo grade ≥III 6%), with the highest recorded incidence for persistent air leak >5 days (5%). Median postoperative length of stay was 4 days (interquartile range 3-6) and 0.7% underwent a repeat pleurodesis for ipsilateral recurrence. Complication rate and length of stay differed considerably between hospitals. There were no differences between the surgical procedures. In the Netherlands, surgical patients with primary spontaneous pneumothorax are preferably treated with bullectomy plus pleurodesis. Postoperative complications and length of stay vary widely and are considerable in this young patient group. This may be reduced by optimization of surgical care.
摘要：
目的：原发性自发性气胸的最佳手术策略仍存在争议，预计手术实践会有所不同。这种变化可能会影响临床结果，如术后并发症和住院时间。这项以人口为基础的国家注册研究提供了荷兰当前外科手术实践和结果变化的概述和程度。
方法：为了确定治疗原发性自发性气胸的国家护理模式和医院间差异，在2014-2021年期间接受胸膜固定术和/或大疱切除术的患者,从荷兰肺癌审核-外科数据库中确定.手术干预的类型，术后并发症,记录住院时间和同侧复发。
结论：在4,338例患者中，1,851例患者被确定为原发性自发性气胸。中位年龄为25岁（四分位距20-31），男性占82％。执行最多的外科手术是胸膜固定术（83％）。总并发症发生率为12%（ClavienDindo分级≥III级6%），持续漏气>5天的发生率最高(5%)。术后中位住院时间为4天（四分位距3-6），并且0.7％的患者因同侧复发而进行了重复胸膜固定术。医院之间的并发症率和住院时间差异很大。外科手术之间没有差异。在荷兰,患有原发性自发性气胸的手术患者最好接受大泡切除术加胸膜固定术治疗。术后并发症和住院时间差异很大，在这个年轻患者组中相当大。这可以通过优化手术护理来减少。
方法：为了确定治疗原发性自发性气胸的国家护理模式和医院间差异，在2014-2021年期间接受胸膜固定术和/或大疱切除术的患者,从荷兰肺癌审核-外科数据库中确定.手术干预的类型，术后并发症,记录住院时间和同侧复发。
结论：在4,338例患者中，1,851例患者被确定为原发性自发性气胸。中位年龄为25岁（四分位距20-31），男性占82％。执行最多的外科手术是胸膜固定术（83％）。总并发症发生率为12%（ClavienDindo分级≥III级6%），持续漏气>5天的发生率最高(5%)。术后中位住院时间为4天（四分位距3-6），并且0.7％的患者因同侧复发而进行了重复胸膜固定术。医院之间的并发症率和住院时间差异很大。外科手术之间没有差异。在荷兰,患有原发性自发性气胸的手术患者最好接受大泡切除术加胸膜固定术治疗。术后并发症和住院时间差异很大，在这个年轻患者组中相当大。这可以通过优化手术护理来减少。
