Short-term Physiological Changes After VATS for Secondary Spontaneous Pneumothorax in COPD

Objectives: Secondary spontaneous pneumothorax (SSP) is a severe complication in patients with chronic obstructive pulmonary disease (COPD) and is frequently associated with prolonged air leaks. This study aimed to describe the surgical outcomes and short-term changes in pulmonary function (PF) following video-assisted thoracoscopic surgery (VATS) for SSP in patients with COPD. Methods: We conducted a retrospective descriptive study of 60 patients with SSP secondary to COPD who presented with a persistent air leak (PAL) lasting >72 hours following initial pleural drainage. All patients underwent VATS with bullae suturing and/or resection at 115 People’s Hospital in Ho Chi Minh City between July 2023 and December 2024. Preoperative and postoperative PF were assessed using the forced expiratory volume in one second (FEV₁) and the FEV₁/forced vital capacity (FEV₁/FVC) ratio. Surgical outcomes were categorized based on the duration of the postoperative air leak. Results: The mean patient age was 65.4 ± 4.6 years, and the majority of the cohort consisted of smokers with localized or diffuse bullous disease identified on computed tomography. Postoperative FEV₁ increased from 73 ± 12% to 79 ± 7.4% of the predicted value (p = 0.037), and the FEV₁/FVC ratio increased from 53.3 ± 10.6% to 64.6 ± 4.7% (p = 0.043). Favorable surgical outcomes were observed in 66% of the patients. Postoperative pneumonia and prolonged air leaks occurred more frequently in patients presenting with bilateral diffuse bullae and poor nutritional status. Conclusions: VATS with bullae suturing or resection was associated with the resolution of PAL and modest short-term improvements in PF. These changes likely reflect lung re-expansion following air leak closure rather than a true physiological improvement in the underlying COPD-related airflow limitation.