Drainless thoracoscopic surgery for primary spontaneous pneumothorax: A propensity-matched study

Drainless thoracoscopic surgery, which avoids chest drainage after surgery, has been controversial for the treatment of primary spontaneous pneumothorax. This study aimed to demonstrate the postoperative outcomes of drainless thoracoscopic surgery in a select cohort of patients with primary spontaneous pneumothorax. This retrospective study enrolled patients who underwent thoracoscopic surgery for primary spontaneous pneumothorax between August 2016 and December 2021 at Far-Eastern Memorial Hospital, New Taipei City, Taiwan. A group of patients was carefully selected from the cohort to undergo a drainless procedure. Clinical characteristics and postoperative outcomes were compared between propensity score-matched patients with and without chest drains. Among the 198 patients enrolled, 54 and 144 were assigned to the drainless and drain groups, respectively. After propensity score matching, 54 patients in both the groups had similar clinical characteristics. Compared to the drain group, the drainless group had a shorter hospital stay [Median (Interquartile range), 2 (1–2) versus 2 (2–3), p < 0.001] and lesser postoperative pain [1 (0–2) versus 3 (2–3), p < 0.001], but there were no significant between-group differences in postoperative complications [3 (5.55 %) cases in drainless group versus 2 (3.70 %) in drain group, p = 0.480] and disease recurrence [3 (5.56 %) cases in the drainless group versus 5 (9.26 %) in the drain group, p = 0.727]. Drainless thoracoscopic surgery is associated with reduced pain and shorter hospital stay without compromising postoperative outcomes including disease recurrence. Hence, it may be advantageous for a carefully selected cohort of patients with primary spontaneous pneumothorax.