Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment

Abstract International guidelines do not recommend surgery for the first episode of primary spontaneous pneumothorax (PSP), except in cases of persistent air leak, hemopneumothorax, bilateral pneumothorax, or occupations at risk. However, these recommendations have been challenged because of a signi...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Hsin-Yi Chiu, Yi-Chia Ho, Pei-Chen Yang, Chi-Ming Chiang, Cheng-Chin Chung, Wei-Ciao Wu, Yu-Cih Lin, Chien-Yu Chen, Yu-Chung Wu
Formato: article
Lenguaje:EN
Publicado: Nature Portfolio 2021
Materias:
R
Q
Acceso en línea:https://doaj.org/article/9cca82c42fd14d218933f757525e0edd
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:9cca82c42fd14d218933f757525e0edd
record_format dspace
spelling oai:doaj.org-article:9cca82c42fd14d218933f757525e0edd2021-12-02T14:49:10ZRecommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment10.1038/s41598-021-90113-w2045-2322https://doaj.org/article/9cca82c42fd14d218933f757525e0edd2021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90113-whttps://doaj.org/toc/2045-2322Abstract International guidelines do not recommend surgery for the first episode of primary spontaneous pneumothorax (PSP), except in cases of persistent air leak, hemopneumothorax, bilateral pneumothorax, or occupations at risk. However, these recommendations have been challenged because of a significant reduction in the recurrence rate in emerging studies. We evaluated the rationale of recommendations by systematically reviewing RCTs and observational studies by using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. We searched articles in PubMed, EMBASE, and Cochrane databases up to August 15, 2020. The primary outcomes were the recurrence rate and complication rate. The secondary outcomes were hospital stay and drainage duration. Nine eligible studies with 1121 patients were retrieved and analyzed. The recurrence rate was lower in the VATS than in conservative treatment with moderate evidence (OR 0.13, 95% CI 0.09 to 0.19, P < 0.001, I2 = 0%). We did not find significant differences in complication rate (Peto OR 1.17, 95% CI 0.33 to 4.12, P = 0.80), hospital stay duration (MD − 0.48 days, 95% CI − 2.84 to 1.87, P = 0.69, very low evidence), and in drainage duration (MD − 3.99 days, 95% CI − 9.06 to 1.08, P = 0.12, very low evidence) between the two groups. Our results would suggest VATS treatment as a weak recommendation for patients with the first episode of PSP, based on our systematic review of the current evidence by using the GRADE system, indicating that different treatments will be appropriate for different patients and that patients’ values and preferences should be incorporated through shared decision making. Trial REGISTRY: PROSPERO; No.: CRD42020162267.Hsin-Yi ChiuYi-Chia HoPei-Chen YangChi-Ming ChiangCheng-Chin ChungWei-Ciao WuYu-Cih LinChien-Yu ChenYu-Chung WuNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Hsin-Yi Chiu
Yi-Chia Ho
Pei-Chen Yang
Chi-Ming Chiang
Cheng-Chin Chung
Wei-Ciao Wu
Yu-Cih Lin
Chien-Yu Chen
Yu-Chung Wu
Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
description Abstract International guidelines do not recommend surgery for the first episode of primary spontaneous pneumothorax (PSP), except in cases of persistent air leak, hemopneumothorax, bilateral pneumothorax, or occupations at risk. However, these recommendations have been challenged because of a significant reduction in the recurrence rate in emerging studies. We evaluated the rationale of recommendations by systematically reviewing RCTs and observational studies by using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system. We searched articles in PubMed, EMBASE, and Cochrane databases up to August 15, 2020. The primary outcomes were the recurrence rate and complication rate. The secondary outcomes were hospital stay and drainage duration. Nine eligible studies with 1121 patients were retrieved and analyzed. The recurrence rate was lower in the VATS than in conservative treatment with moderate evidence (OR 0.13, 95% CI 0.09 to 0.19, P < 0.001, I2 = 0%). We did not find significant differences in complication rate (Peto OR 1.17, 95% CI 0.33 to 4.12, P = 0.80), hospital stay duration (MD − 0.48 days, 95% CI − 2.84 to 1.87, P = 0.69, very low evidence), and in drainage duration (MD − 3.99 days, 95% CI − 9.06 to 1.08, P = 0.12, very low evidence) between the two groups. Our results would suggest VATS treatment as a weak recommendation for patients with the first episode of PSP, based on our systematic review of the current evidence by using the GRADE system, indicating that different treatments will be appropriate for different patients and that patients’ values and preferences should be incorporated through shared decision making. Trial REGISTRY: PROSPERO; No.: CRD42020162267.
format article
author Hsin-Yi Chiu
Yi-Chia Ho
Pei-Chen Yang
Chi-Ming Chiang
Cheng-Chin Chung
Wei-Ciao Wu
Yu-Cih Lin
Chien-Yu Chen
Yu-Chung Wu
author_facet Hsin-Yi Chiu
Yi-Chia Ho
Pei-Chen Yang
Chi-Ming Chiang
Cheng-Chin Chung
Wei-Ciao Wu
Yu-Cih Lin
Chien-Yu Chen
Yu-Chung Wu
author_sort Hsin-Yi Chiu
title Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
title_short Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
title_full Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
title_fullStr Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
title_full_unstemmed Recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
title_sort recommendation for management of patients with their first episode of primary spontaneous pneumothorax, using video-assisted thoracoscopic surgery or conservative treatment
publisher Nature Portfolio
publishDate 2021
url https://doaj.org/article/9cca82c42fd14d218933f757525e0edd
work_keys_str_mv AT hsinyichiu recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT yichiaho recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT peichenyang recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT chimingchiang recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT chengchinchung recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT weiciaowu recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT yucihlin recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT chienyuchen recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
AT yuchungwu recommendationformanagementofpatientswiththeirfirstepisodeofprimaryspontaneouspneumothoraxusingvideoassistedthoracoscopicsurgeryorconservativetreatment
_version_ 1718389526510960640