Surgical Management of Secondary Spontaneous Pneumothorax in Elderly Patients with Chronic Obstructive Pulmonary Disease: Retrospective Study of 107 Cases

Abstract

Background: Aim of the study was to assess the results of surgery for secondary spontaneous pneumothorax (SSP) in the elderly with COPD at Shanghai Pulmonary Disease Hospital. Methods: From 1 January 1993 to 30 June 2007, the operation for SSP was performed in 107 elderly patients (≥ 60y) with COPD. All patient data was reviewed retrospectively. Results: Morbidity was 25.2 % and mortality was 4.7 %. The total effective rate of intrapleural injection of human fibrinogen for the treatment of postoperative persistent air leaks was 86.7 %. Multivariate analyses of postoperative air leaks suggest that patients undergoing pleurodesis (OR 0.189, 95 % CI 0.045–0.790, p = 0.022) have a decreased risk of postoperative air leaks. Multivariate analyses of postoperative complications suggest that patients with higher PaCO₂ (OR 0.890, 95 % CI 0.814–0.973, p = 0.011) have an increased risk and patients undergoing pleurodesis (OR 4.319, 95 % CI 1.398–13.349, p = 0.011) have a decreased risk. Conclusions: Surgical intervention is recommended in selected elderly COPD patients with SSP, with hypercapnia known as an operative contraindication. Additionally, surgery offers the advantage of intraoperative pleurodesis for the prevention of prolonged postoperative air leaks, while intrapleural injection of human fibrinogen is an effective procedure in the treatment of air leaks.