Joined: 05 Feb 2006
Location: Devon, UK
|Posted: Sun Mar 05, 2006 1:25 pm Post subject: Recurrence rates
(please note these are figures taken from "BTS guidelines" research, and do not necessarily represent the true figures worldwide - but are certainly a good start for comparison).
Observation 70-80% of pneumothoraces estimated at smaller than 15% have no persistent air leak and recurrence in those managed with observation alone is less than in patients treated with intercostal tube drainage.
If left untreated, recurrence rates of a spontaneous pneumothorax are high. Same side recurrence rates as high as 30% at six months and up to 50% at 2 years, without treatment have been reported.
Simple Aspiration / Intercostal tube drainage In a prospective randomised trial to compare simple aspiration and tube drainage of pneumothoraces, Andrivert and colleagues found a 20% recurrence rate at 3 months after simple aspiration of primary pneumothoraces and a 28% recurrence rate after tube drainage demonstrating that simple aspiration is no less effective from the point of view of recurrence than the more invasive intercostal tube drainage.
Thoracotomy / VATS Recurrence rates of pneumothorax after VATS are 5-10%, which are higher than the 1% rates reported after open procedures. Open thoracotomy yields the lowest postoperative recurrence results.
Minithoracotomy The largest series examining this technique reported a mean hospital stay of 6 days, a recurrence rate of 0.4%
Pleurodesis / Pleurectomy There is debate between those who favour surgical pleurodesis or pleural abrasion versus those who favour partial or total pleurectomy as a definitive treatment to prevent recurrence of pneumothorax, although a relatively recent comprehensive review of this area suggests a slight advantage of pleurectomy over pleural abrasion with a recurrence rate of 0.4% after pleurectomy and 2.3% after pleural abrasion.
Chemical pleurodesis The rate of recurrence of pneumothorax is the primary indicator of success for any sclerosant. Although tetracycline has been shown significantly to reduce the incidence of early recurrence, the incidence of late recurrence is 10-20% which is unacceptably high compared with surgical methods of pleurodesis. Its recurrence rate is lower than that of tube drainage but higher than that of surgical treatment.
Surgical chemical pleurodesis Displayed recurrence rates of 16% in a series of 390 patients who underwent surgical pleurodesis using tetracycline.
Talc pleurodesis The overall success rate for talc pleurodesis reviewed by meta-analysis is 91%.
Staple line buttress - Peri-Strips / INSTAT The average time to chest tube removal has been found to be 8.6 +/- 7.2 days for Peri-Strips and 10.7 +/- 8.7 days for INSTAT from article