Long-Term Results of Expectant Management of First Episode of Primary Spontaneous Pneumothorax: Is it a Safe Therapeutic Option?

ABSTRACT

Introduction: Expectant treatment in clinically stable patients with small primary spontaneous pneumothorax (PSP) remains in discussion, partly due to the described increased recurrence rate compared to patients treated with pleural drainage. Objective: To present the experience in the management of grade I PSP, comparing long- and short-term results of patients treated with pleural drainage with those treated expectantly. Methods: We present a retrospective study of patients diagnosed with small asymptomatic or mildly symptomatic PSP. Results: 34 out of 69 patients were treated with pleural drainage and 35 underwent expectant treatment with outpatient management. Both groups were comparable regarding sex, side, size of pneumothorax and history of tobacco smoking. As for the short-term results, there weren't any differences between groups in success therapy, but there were significant differences related to hospital stay, where patients treated with pleural drainage presented longer length of stay. Regarding long-term results, there weren't significant differences in terms of recurrence between both groups. Conclusion: The expectant management of clinically stable patients with small primary spontaneous pneumothorax with strict ambulatory control follow-up and those who comply with treatment recommendations and can obtain prompt emergency medical care presents acceptable long- and short-term results and should be the first choice of treatment.