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Pleural disease
Safety and efficacy of ambulatory management of secondary spontaneous pneumothorax: a case series
  1. Fasih Khan,
  2. Yusuf Vali,
  3. Muhammad Naeem and
  4. Raja Reddy
  1. Respiratory Medicine, Kettering General Hospital NHS Foundation Trust, Kettering, UK
  1. Correspondence to Dr Raja Reddy; rvreddy51{at}hotmail.com

Abstract

Introduction The optimal management of pneumothorax remains undefined. There is a growing consensus that patients with spontaneous pneumothorax can be considered for ambulatory management with the use of a one-way valve. Despite this, there is little data on the outcomes of outpatient management of secondary spontaneous pneumothorax (SSP).

Methods At our institution, selected patients with primary and secondary spontaneous pneumothorax who meet the predefined local criteria are managed on an ambulatory pathway. We prospectively evaluated our practice over a 3-year period and explore outcomes of patients with SSP using primary spontaneous pneumothorax (PSP) as a comparator group.

Results 163 consecutive patients presenting to our hospital between September 2014 and July 2017 were evaluated using a predefined protocol. 111 (49 SSP and 62 PSP) were deemed suitable for outpatient management. Resolution on day 5 was similar between the two groups (65% in the SSP vs 79% in the PSP group; p=0.108). The mean drainage time was 5.84 days in SSP compared with 5.69 days in PSP, representing a difference of 0.15 days (95% CI −2.47 to 2.16; p=0.897). Complications such as infection and drain blockage/falling-out were scarce, with comparable pain and satisfaction scores across both groups. There were no deaths during this period. An estimated £86 796 ($113 920) was saved over the study period, equating to £1118.80 ($1550) per patient.

Discussion This study suggests that outpatient management of selected patients with SSP may be effective, safe and cost-saving.

  • pneumothorax
  • primary spontaneous pneumothorax
  • spontaneous pneumothorax
  • pleural catheter
  • pleural diseases
  • ambulatory care
  • secondary spontaneous pneumothorax

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2018-000373

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    Footnotes

    • Contributors All authors contributed to the authorship of the document. FK wrote the paper and did all the statistical analyses. RR collected all the data. RR, YV and MN designed and conducted the study, as well as revised the paper. All authors approved the final work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval As this was an evaluation of our service, the institution's R&D office had confirmed that research approval was not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.