PM1063: Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with simple aspiration.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2021. Initial management consisted of aspiration alone with ≤12F thoracostomy tube followed by clamping of the tube and chest radiograph at 6 hours. Success was defined as < 2cm distance between the chest wall and lung at the apex or no air leak when the clamp is released. VATS was performed if aspiration failed.

Results: Fifty-nine patients were initially managed with aspiration, with a median age of 16.8 years (IQR 15.9, 17.3). Most patients were male (n=45, 76.2%) and white (n=50, 85%). Left sided pneumothorax was more common (n=38, 64%). Overall median LOS was 2.7 days (IQR 1, 3.5).
Aspiration was successful in 33% (20) of the patients and were subsequently discharged home, while 66% (39) required VATS. The median LOS for those with successful aspiration during the index admission was 20.4 hours (IQR 16.8, 34.8), while those who underwent VATS had a median LOS of 3.1 days (IQR 2.6, 4). In comparison, in the MWPSC study, of which our site was a participant, the mean LOS for those managed with a chest tube after failed aspiration without progressing directly to VATS was 6.0 days (± 5.5).
Of those who had successful aspiration, 45% (9) had recurrent PSP, of which 1 had another successful aspiration and 8 required VATS after failed aspiration.
Of the 39 patients who initially underwent VATS after a failed aspiration, 25% (10) had recurrent PSP, of which 1 went on to have successful aspiration and 90% (9) required repeat VATS. The median time to recurrence for the successful aspiration group was shorter than that of the VATS group [66.6 days +/- 41.3 vs. 546.5 days +/- 166.5 (p=0.02)].

Conclusion: Simple aspiration is safe and effective for children with PSP as initial management, although most will require VATS either due to failed aspiration or recurrence of PSP. Early VATS appears to reduce the overall length of stay.