Outpatient Drainage Therapy with a Thoracic Vent for Traumatic Pneumothorax due to Bull Attack

Thoracoscopic Surgery for Pneumothorax Following Outpatient Drainage Therapy

PURPOSE

We investigated the outcomes of surgery for pneumothorax following outpatient drainage therapy.

METHODS

We reviewed the records of 34 patients who underwent operations following outpatient drainage therapy with the Thoracic Vent at our hospital between December 2012 and September 2016. Indications for outpatient drainage therapy were pneumothorax without circulatory or respiratory failure and pleural effusion. Indications for surgical treatment were persistent air leakage and patient preference for surgery to prevent or reduce the incidence of recurrent pneumothorax.

RESULTS

Intraoperatively, 9 of 34 cases showed loose adhesions around the Thoracic Vent, all of which were dissected bluntly. The preoperative drainage duration ranged from 5 to 13 days in patients with adhesions and from 3 to 19 days in those without adhesions, indicating no significant difference. The duration of preoperative drainage did not affect the incidence of adhesions. The operative duration ranged from 30 to 96 minutes in patients with adhesions and from 31 to 139 minutes in those without adhesions, also indicating no significant difference.

CONCLUSION

Outpatient drainage therapy with the Thoracic Vent was useful for spontaneous pneumothorax patients who underwent surgery, and drainage for less than 3 weeks did not affect intraoperative or postoperative outcomes.

Outpatient drainage for patients with spontaneous pneumothorax over 50 years of age

Introduction:

The British Thoracic Society has reported a lower success rate for aspiration of spontaneous pneumothorax in patients over 50 years of age. Outpatient drainage therapy is used to manage spontaneous pneumothorax at some institutions. We examined the effect of age on outpatient drainage therapy outcomes.

Materials and Methods:

We reviewed the records of 68 patients who underwent outpatient drainage therapy with a thoracic vent between December 2012 and April 2015, which included 11 patients over 50 years of age. Indications for outpatient drainage therapy included pneumothorax with no circulatory or respiratory failure and no pleural effusion.

Results:

Of the 11 patients over 50 years of age, 5 had chronic obstructive pulmonary disease (COPD), one had interstitial pneumonia, one had a history of pulmonary tuberculosis, and one has lung tumors (LTs). Among the 57 younger patients, 2 patients had COPD, and one had LTs. Unexpected hospital admission occurred in 2 patients over 50 years of age and one patient aged 50 years or less (P = 0.0658, Fisher's exact test). Six of the 11 patients over 50 years of age underwent surgery for prolonged air leakage, compared to 8 of the 57 younger patients (P = 0.00695, Fisher's exact test).

Conclusions:

Outpatient drainage therapy is useful for patients with spontaneous pneumothorax over 50 years of age, because outpatient drainage therapy alone was successful in 4 of 11 patients and admission for drainage was avoided in 9 of 11 patients. However, prolonged air leakage occurs more frequently in this age group.

Effectiveness of Ambulatory Tru-Close Thoracic Vent for the Outpatient Management of Pneumothorax: A Prospective Pilot Study

Objective

This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax.

Materials and Methods

From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16–64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance.

Results

Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0–5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3–13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016.

Conclusion

TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

Outpatient Treatment of Pneumothorax with a Thoracic Vent: Economic Benefit

BACKGROUND

Since rising medical costs currently represent a growing problem worldwide, finding cost-effective treatment options is important. In our hospital, outpatient treatment of pneumothorax using a thoracic vent began in December 2012.

OBJECTIVES

We aimed to test our hypothesis that outpatient treatment of pneumothorax with a thoracic vent can reduce medical expenses.

METHODS

Patients were classified into four groups based on treatment: thoracic vent with or without surgery or conventional intercostal chest tube drainage with or without surgery. We compared mean medical expenses, duration of hospitalization and number of physician visits among these four groups.

RESULTS

During a 2-year period, 65 patients were treated with a thoracic vent (36 patients) or conventional intercostal chest tube drainage (29 patients). Patients treated with a thoracic vent who underwent surgery had a shorter mean duration of hospitalization (5.0 ± 1.3 vs. 10.3 ± 3.4 days; p < 0.0001) and lower overall cost, at JPY 971,830.00 ± 81,291.80 (USD 10,400.40 ± 1,464.90) versus JPY 1,179,791.10 ± 198,383.10 (USD 13,888.90 ± 1,965.30; p < 0.0001) compared with conventional intercostal chest tube drainage. Nonsurgical patients treated with a thoracic vent had lower overall costs, at JPY 79,960.00 ± 25,643.60 (USD 890.10 ± 352.30) versus JPY 268,588.80 ± 94,636.50 (USD 2,932.80 ± 903.50; p < 0.0001) compared with conventional intercostal chest tube drainage. No serious complications were observed.

CONCLUSIONS

Outpatient thoracic vent treatment can significantly reduce medical expenses and thereby have a major economic impact.