Surgical management patterns for spontaneous pneumothorax in adolescents and young adults.

BACKGROUND

Management of primary spontaneous pneumothorax varies widely. We aimed to assess national trends in PSP management in the last decade.

METHODS

We conducted a 10-year retrospective analysis of the MarketScan claims database to identify adolescents and young adults (aged 10-24 years) diagnosed with primary spontaneous pneumothorax (2012-2021). Outcomes during index admission and recurrence included imaging, drainage procedures (aspiration or tube thoracostomy), surgery, and length of stay. Thirty-day postoperative outcomes included emergency department visits, readmission, and return to the operating room.

RESULTS

Among 2,480 patients (mean age 18.9 years; 83.7% male), 41.5% underwent a computed tomography scan of the chest. During index admission, 60.9% underwent a drainage procedure. Surgeries were performed in 32.3% (n = 801) of patients after a mean of 4.1 (standard deviation, 2.7) days. Over the 10-year period, the use of cross-sectional imaging utilization increased (odds ratio, 1.04; 95% confidence interval, 1.01-1.07, P = .008) but time to surgical intervention remained unchanged. Median length of stay was 4 days (interquartile range, 2-6). Those who underwent surgery were less likely to experience readmission (4.9% vs 19.8%, P < .001) or have an visit to the emergency department (12.6% vs. 21.7%, P < .001) within 30 days compared with those with no surgery. At 1 year, approximately 9.5% of patients experienced a recurrence that resulted in an admission, with nearly 75% undergoing surgery.

CONCLUSION

Management of primary spontaneous pneumothorax in adolescents and young adults varies based on clinical presentation and patient factors. Reducing the use of computed tomography and expediting decision-making process for proceeding to the operating room may serve as potential targets for optimizing health care resource use.