B. Zhang1, J. Williams1, H. Palmerton1, G. Pak1, J. Kuckelman2, D. Cuadrado2, M. DeBarros2 1Madigan Army Medical Center, General Surgery, Tacoma, WA, USA 2Madigan Army Medical Center, Thoracic Surgery, Tacoma, WA, USA
Introduction: Primary spontaneous pneumothorax (PSP) is a common benign thoracic condition. Management of PSP varies from tube thoracostomy to surgical interventions. We examined the differences between PSP management between the unique environments of military and civilian healthcare facilities (MIL vs. CIV
Methods: A retrospective review was conducted of the Department of Defense insurance claims database from 2015-2022. All admissions for PSP were identified. We compared management and outcomes between MIL and CIV practices.
Results: There was a total of 337 patients included for analysis with an overall incidence rate of 5.0/100,000 person years. CIV management was associated with longer median length of stay in days (3.0 (IQR 3) vs 4.0 (IQR 4), p=0.045). Overall median costs were similar, ($20,268 (IQR $28,003) vs $15,680 (IQR $35,859), p=0.944). Operative costs after nonoperative recurrence had similar median costs to initial operative management ($43,423 (IQR $41,281), operative vs $50,172 (IQR $41,636), nonoperative, p=0.298), however, nonoperative recurrence management was associated with significantly longer median length of stay at 8 days (IQR 5) vs 5 days (IQR 4, p<0.001).
Conclusion: Current management guidelines advocate for conservative management as first-line treatment. Our findings indicate initial operative management is associated with lower length of stay and with low rates of recurrence when operative management is utilized as first-line treatment. Current guidelines should be updated, and operative management should be considered as first line therapy for PSP whenever the clinical scenario allows.