Predictive Factors of Chest Drainage Failure in the First Episode of Primary Spontaneous Pneumothorax

Abstract

<bold>Introduction:</bold> Chest drainage is a common treatment for primary spontaneous pneumothorax (PSP), but its failure can lead to prolonged hospitalization and the need for surgery. Identifying predictive factors of drainage failure could help optimize management by guiding early surgical intervention. This study aimed to identify factors associated with chest drainage failure in patients with a first episode of PSP. <bold>Methods:</bold> We conducted a retrospective study including 172 patients hospitalized for PSP in the pulmonology and thoracic surgery departments of Charles Nicolle Hospital between January 2018 and December 2022. Patients were divided into two groups : G1 (n=63) with drainage failure and G2 (n=109) with successful drainage. <bold>Results:</bold> The mean age was 30.1 ± 8.7 years. Cannabis smokers had a higher rate of drainage failure (p=0.4, OR=1.25, [0.7-2.3]). Patients with drainage failure had more frequent initial dyspnea (p=0.3, OR=1.35, [0.7-2.5]), subcutaneous emphysema (p=0.3, OR=1.8, [0.5-7.3]), large pneumothorax (p=0.1, OR=2.5, [0.7-9.1]), and total pneumothorax (p=0.05, OR=3.8, [0.8-17.4]). The presence of blebs on chest scan was more frequent in the G1 (p=0.08, OR=7, [0.7-70.7]). Besides, the presence of emphysema on chest CT was identified as a predictive factor of drainage failure (p=0.03, OR=3.5, [1.2-9.5]). <bold>Conclusion:</bold> Total pleural detachment and the presence of emphysema on CT appear to be risk factors for failed chest drainage in patients hospitalised for primary spontaneous pneumothorax and should be considered to guide initial management strategies.