A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax |
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Authors: | C H Cook W S Melvin J I Groner E Allen D R King |
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Institution: | (1) Departments of Surgery, The Ohio State University Hospitals and Columbus Children's Hospitals, N-747 Doan Hall, 410 West Tenth Avenue, Columbus, OH 43210, USA, US |
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Abstract: | Background: Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary
spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly
less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric
PSP.
Methods: We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June
30, 1996.
Results: Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 ± 1.1 years, boy–girl ratio 4:1, median body
mass index 18 (normal, 20–25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14
with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent
pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence
resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence
of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000.
In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a
single recurrence would be $230,000.
Conclusions: A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation,
followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax.
Received: 15 May 1998/Accepted: 15 January 1999 |
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Keywords: | : Cost effective — Pediatric — Spontaneous pneumothorax — VATS |
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