Association Between Postoperative NSAID and Chest Drainage Duration After VATS Pleurodesis

Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are a cornerstone of multimodal postoperative analgesia. However, their use remains controversial in surgery for spontaneous pneumothorax because inflammation plays a key role in the development of pleural symphysis during pleurodesis. This retrospective study aimed to evaluate the impact of postoperative NSAID administration after thoracoscopic surgery for spontaneous pneumothorax on chest drainage duration. We conducted a monocentric retrospective observational study including patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax between January 1, 2015, and December 31, 2020. The primary endpoint was prolonged chest drainage, defined as drainage lasting ≥ 3 postoperative days. Secondary endpoints included early markers of pleural symphysis, postoperative analgesia, and postoperative complications. A total of 558 patients were included, of whom 245 (44%) received postoperative NSAIDs and 313 (56%) did not. In multivariable logistic regression, NSAIDs administration was significantly associated with a reduced risk of prolonged chest drainage (OR 0.62; 95%CI: 0.44–0.89; p = 0.009). This association remained consistent after propensity score weighting (IPTW OR 0.66; 95%CI: 0.46–0.95) and sensitivity analyses. No significant differences were observed between the groups regarding postoperative complications or pleurodesis efficacy. The use of patient-controlled opioid analgesia was significantly lower in the NSAID group (p < 0.001). Postoperative NSAID administration was associated with a reduced incidence of prolonged chest drainage, without evidence of worse early postoperative outcomes. These findings do not support impaired short-term pleural symphysis, although definitive conclusions on long-term pleurodesis efficacy would require prospective studies with extended follow-up.