Management practice and outcome for primary spontaneous pneumothorax – a retrospective study

<bold>Introduction:</bold> We observed poor adherence to guideline-based treatment for primary spontaneous pneumothorax (PSP). <bold>Aim:</bold> To investigate the local situation of first episode of PSP admissions in public hospitals in Hong Kong West cluster. <bold>Methods:</bold> Adult patients admitted for first episode PSP in 2016-2020 were reviewed. Primary outcome measure was recurrence with at least 3 years of follow up. Secondary outcome measures included risk factors of recurrence and length of hospital stay (LOS). <bold>Results:</bold> 137 PSP patients were included. 21 (15.3%) patients had recurrence, median time to recurrence: 176 days (IQR: 41.5, 419.5days). Apical pneumothorax (OR: 4.122, p=0.009) was associated with a higher risk of recurrence. Surgical treatment was associated with a lower risk of recurrence (OR: 0.31, p=0.025). Conservative treatment (OR: 2.5, p=0.09) or needle aspiration (OR: 1.864, p=0.316) did not increase risk of recurrence. 9 patients received chemical pleurodesis, and 1 had recurrence. The average LOS was 11.4 days (0-38 days, SD: 8.8 days). Small pneumothorax had shorter LOS when compared to larger pneumothorax (2.59 days vs 13.06 days; p<0.001). Surgery was associated with the longest LOS (17.5 days, p<0.001). In patients who received treatment other than surgery, the LOS was shortest in those who received conservative management (2.5 days, p<0.001). Intercostal chest tube drain was associated with longer LOS in non-surgical patients (10.69 days, p<0.001). <bold>Conclusions:</bold> Around 15% of PSP had recurrence. Conservative treatment of PSP gave the shortest LOS and did not increase risk of recurrence. Surgical treatment gave the longest LOS but the lowest risk of recurrence.