Frontiers in medicine · 2026
Inflammatory biomarkers and 30-day thoracic outcomes after surgical versus non-surgical management of spontaneous pneumothorax: a retrospective cohort study.
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Ding Qingguo, Ruan Yingding, Long Chuan, Cao Wenjun, Yang Aiming, Sun Peng, Han Jianwei
Аннотация
BACKGROUND: Systemic inflammatory biomarkers may reflect early recovery after spontaneous pneumothorax, but their association with short-term outcomes after surgical versus non-surgical management remains uncertain. This study evaluated inflammatory indices and 30-day thoracic outcomes after different treatment strategies.
METHODS: We retrospectively analyzed 320 eligible spontaneous pneumothorax episodes treated between January 2017 and December 2024, including 120 managed with video-assisted thoracoscopic surgery and 200 managed without surgery. The primary analysis was episode-based, with a patient-level sensitivity analysis retaining the first eligible episode per patient. The primary outcome was any thoracic complication within 30 days after discharge, and the secondary outcome was hospital stay after the index procedure. Stabilized inverse probability of treatment weighting was used to adjust baseline differences. Treatment-outcome associations were estimated using weighted regression models.
RESULTS: After weighting, video-assisted thoracoscopic surgery was associated with higher post-treatment inflammatory indices, including SII, PLR, NLR, and WBC, but lower LMR, albumin, and hemoglobin. Compared with non-surgical management, video-assisted thoracoscopic surgery was associated with fewer 30-day post-discharge thoracic complications (13.2% vs. 28.5%, p < 0.001), but longer hospital stay after the index procedure (median 5.00 vs. 3.00 days, p < 0.001) and more frequent antibiotic use (26.2% vs. 7.7%, p < 0.001). In weighted models, surgery remained associated with a lower risk of 30-day post-discharge thoracic complications (OR = 0.38, 95% CI = 0.21-0.71, p = 0.002) and longer hospital stay after the index procedure (β = 1.91 days, 95% CI = 0.34-3.49, p = 0.017).
CONCLUSION: Video-assisted thoracoscopic surgery was associated with fewer 30-day post-discharge thoracic complications but longer hospitalization in spontaneous pneumothorax. Elevated post-treatment inflammatory biomarkers after surgery may reflect surgical stress rather than infection alone and should be interpreted cautiously.
METHODS: We retrospectively analyzed 320 eligible spontaneous pneumothorax episodes treated between January 2017 and December 2024, including 120 managed with video-assisted thoracoscopic surgery and 200 managed without surgery. The primary analysis was episode-based, with a patient-level sensitivity analysis retaining the first eligible episode per patient. The primary outcome was any thoracic complication within 30 days after discharge, and the secondary outcome was hospital stay after the index procedure. Stabilized inverse probability of treatment weighting was used to adjust baseline differences. Treatment-outcome associations were estimated using weighted regression models.
RESULTS: After weighting, video-assisted thoracoscopic surgery was associated with higher post-treatment inflammatory indices, including SII, PLR, NLR, and WBC, but lower LMR, albumin, and hemoglobin. Compared with non-surgical management, video-assisted thoracoscopic surgery was associated with fewer 30-day post-discharge thoracic complications (13.2% vs. 28.5%, p < 0.001), but longer hospital stay after the index procedure (median 5.00 vs. 3.00 days, p < 0.001) and more frequent antibiotic use (26.2% vs. 7.7%, p < 0.001). In weighted models, surgery remained associated with a lower risk of 30-day post-discharge thoracic complications (OR = 0.38, 95% CI = 0.21-0.71, p = 0.002) and longer hospital stay after the index procedure (β = 1.91 days, 95% CI = 0.34-3.49, p = 0.017).
CONCLUSION: Video-assisted thoracoscopic surgery was associated with fewer 30-day post-discharge thoracic complications but longer hospitalization in spontaneous pneumothorax. Elevated post-treatment inflammatory biomarkers after surgery may reflect surgical stress rather than infection alone and should be interpreted cautiously.