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Objective To analyze the risk factors for recurrence of primary spontaneous pneumothorax and to establish a prediction model.Methods The clinical data of 803 patients clearly diagnosed with primary spontaneous pneumothorax in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2021 were retrospectively analyzed,and 70％of the patients were randomly included in the modeling group(562 patients)and 30％in the validation group(241 patients).Risk factors for recurrence were analyzed by univariate and multivariate Cox regression using R 4.2.1 software,and a Nomogram prediction model was developed.Receiver operating characteristic curves were plotted,and the area under the curve(AUC)was calculated to assess model discrimination,and calibration curves were plotted to assess model calibration.Results The overall recurrence rate was 22.67％(182/803).Multivariate Cox regression analysis showed that age,smoking index,dystrophic severity score and treatment regimens were independent risk factors for recurrence of primary spontaneous pneumothorax,and the AUC of the Nomogram prediction model was 71.7％(95％CI 64.1-79.2),with high predictive efficiency.Conclusion This recurrence prediction model of primary spontaneous pneumothorax can assist clinicians to accurately assess the risk of recurrence in individual patients.
RESUMO
PURPOSE: The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice. METHODS: Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate. RESULTS: In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: -2.5 [-4.63, -0.35]) and BT + apical pleurectomy (MD, 95% CI: -2.72 [-5.16, -0.27]). CONCLUSIONS: Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.