Which pneumothorax volume/size measurement method can best predict surgical indication in primary spontaneous pneumothorax patients? A comparison of six different methods

• Published in: General thoracic and cardiovascular surgery 2022-10, Vol.70 (10), p.871-879
• Main Authors: Çıtak, Necati, Özdemir, Servet
• Format: Article
• Language: English
• Subjects: Cardiac Surgery; Cardiology; Chest tubes; Medicine; Medicine & Public Health; Multivariate analysis; Original Article; Patients; Pneumothorax; Surgery; Surgical Oncology; Thoracic Surgery
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-022-01800-y

Objectives We determined whether patients requiring surgery could be identified using pneumothorax volume/size in the first episode of primary spontaneous pneumothorax (PSP) and confirmed which of six different measurement methods of pneumothorax volume/size best predicted surgical indication (prolonged air leak, PAL, or ipsilateral recurrence). Methods Between 2013 and 2017, 282 patients with PSP were analysed. The volume of the pneumothorax (%) was calculated using volumetric methods (Collins, Rhea, Kircher, Light), while its size (large or small) was determined using the British Thoracic Society (BTS) and American College of Chest Physicians (ACCP) guidelines for the first PSP episode. The optimal cut-off points of pneumothorax volume in patients requiring surgery were based on the most sensitive and specific scores, calculated using receiver operating characteristic analysis. Results Surgery was indicated in 162 patients (57.4%) because of PAL ( n  = 92) or ipsilateral recurrence ( n  = 70). Kircher’s method had a better area under the curve (AUC) value than the others (AUC = 0.731, 95% confidence interval [CI] 0.676–0.782). Comparing the calculated cut-off points for each volumetric method and the known thresholds from the BTS/ACCP, the best predictor for surgical indications (for both PAL and ipsilateral recurrence) was Kircher’s method (odds ratio = 5.636, 95% CI 3.338–9.516, p