Respiratory investigation · 2025
Rethinking routine chest drainage in pneumothorax management: Outcomes from a nationwide Japanese database.
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Yamauchi Yoshikane, Sakao Yukinori, Sawabata Noriyoshi, Obuchi Toshiro, Tsuboshima Kenji, Matsutani Noriyuki, Okamoto Shouichi, Igai Hitoshi, Hayashi Akihiro
Аннотация
BACKGROUND: The optimal management of pneumothorax remains controversial, with evolving evidence challenging the conventional approach of routine chest drainage.
METHODS: We analyzed data of 1773 patients (956 with primary spontaneous pneumothorax [PSP], 817 with secondary spontaneous pneumothorax [SSP]) from a nationwide Japanese database. Multivariate and propensity score matching analyses identified factors associated with drainage requirement and compared outcomes between drainage and non-drainage groups.
RESULTS: Pneumothorax grade was the most significant determinant of chest drainage requirement in both PSP (moderate: odds ratio [OR] 12.5, severe: OR 22.6 vs. mild, p < 0.001) and SSP patients (moderate: OR 16.1, severe: OR 26.9 vs. mild, p < 0.001), with chronic obstructive pulmonary disease being an additional factor in SSP (OR 3.04). PSP patients without drainage had shorter hospital stays (median: 6.0 vs. 8.0 days, p < 0.001) and more frequently underwent surgery. SSP patients without drainage had lower ICU admission rates and shorter hospitalization (median: 11.0 vs. 14.0 days, p < 0.001). The benefits of non-drainage were observed across all pneumothorax grades in PSP, while in severe SSP, drainage was associated with better outcomes. After matching for pneumothorax grade, non-drainage PSP patients had shorter stays in both non-surgical (median: 2 vs. 6 days, p < 0.001) and surgical subgroups (median: 5 vs. 8 days, p < 0.001). Mortality rates were comparable between groups.
CONCLUSIONS: While pneumothorax grade remains the key determinant for chest drainage, carefully selected patients may be successfully managed without drainage, with shorter hospital stays without compromising outcomes. Refined criteria for non-drainage management could improve resource utilization and patient experience.
METHODS: We analyzed data of 1773 patients (956 with primary spontaneous pneumothorax [PSP], 817 with secondary spontaneous pneumothorax [SSP]) from a nationwide Japanese database. Multivariate and propensity score matching analyses identified factors associated with drainage requirement and compared outcomes between drainage and non-drainage groups.
RESULTS: Pneumothorax grade was the most significant determinant of chest drainage requirement in both PSP (moderate: odds ratio [OR] 12.5, severe: OR 22.6 vs. mild, p < 0.001) and SSP patients (moderate: OR 16.1, severe: OR 26.9 vs. mild, p < 0.001), with chronic obstructive pulmonary disease being an additional factor in SSP (OR 3.04). PSP patients without drainage had shorter hospital stays (median: 6.0 vs. 8.0 days, p < 0.001) and more frequently underwent surgery. SSP patients without drainage had lower ICU admission rates and shorter hospitalization (median: 11.0 vs. 14.0 days, p < 0.001). The benefits of non-drainage were observed across all pneumothorax grades in PSP, while in severe SSP, drainage was associated with better outcomes. After matching for pneumothorax grade, non-drainage PSP patients had shorter stays in both non-surgical (median: 2 vs. 6 days, p < 0.001) and surgical subgroups (median: 5 vs. 8 days, p < 0.001). Mortality rates were comparable between groups.
CONCLUSIONS: While pneumothorax grade remains the key determinant for chest drainage, carefully selected patients may be successfully managed without drainage, with shorter hospital stays without compromising outcomes. Refined criteria for non-drainage management could improve resource utilization and patient experience.