Video-assisted Thoracoscopic Surgery in Early Evaluation of First Time Spontaneous Pneumothorax： A Retrospective Study

Objective To analyze the differences in efficacy and costs in treating first time spontaneous pneumothorax by conservative therapy （pleural drainage or observation） and video-assisted thoracoscopic surgery （VATS）. Methods 59 Patients with first time spontaneous pneumothorax were retrospectively divided by either a continuous tube thoracostomy with/without negative pressure absorption （group 1,n=31） or VATS （group 2, n=28） after placement of the first chest tube for 48-72 hours. Patients in group 1 with additional intervention failed were divided subsequently randomly to VATS group （n=5） or thoracotomy group （n=10）. Study end points included duration and costs of hospitalization. Results： Patients in group 2 had shorter duration of tube drainage （4.56 1.74, versus 7.63 4±3.46 days, p〈 0.05）, shorter total hospital days （7.84±3.86 versus 10.96±4.27 days, p〈0.05） compared to patients in group 1. Hospital costs were higher in group 2 than that in group 1 （￥15.365±4.478 versus ￥8.894±6.423, p〈0.05）. There was no mortality in either group. No patient of group 2 was required to convert to thoracotomy group. 15 patients of group 1 with prolonged tube placement failed, and this subset was divided to VATS group （n=5） or thoracotomy group （n=10）. No significant difference in clinical outcome was found between with two subgroups. Conclusion： Intent to treat with early VATS for first time spontaneous pneumothorax decreases the duration of tube drainage, the length of hospital days and potentially reducing hospital costs if disposable Endo-devices were not used in VATS.