Kenji Tsuboshima1, Teppei Wakahara2, Yasumi Matoba2, Yoshimasa Maniwa3. 1. Department of Thoracic Surgery and Pneumothorax Center, Takasago Municipal Hospital, Takasago, Japan. Electronic address: drniwatori@smn.enjoy.ne.jp. 2. Department of Thoracic Surgery and Pneumothorax Center, Takasago Municipal Hospital, Takasago, Japan. 3. Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Abstract
BACKGROUND: Video-assisted thoracoscopic surgery is the standard procedure for treatment of spontaneous pneumothorax. However, postoperative recurrence is relatively common even if an absorbable covering sheet is used for reinforcement of the visceral pleura. Injection of a high concentration glucose solution to the thoracic cavity was recently reported to be effective in stopping postoperative air leakage or as a prophylactic procedure to prevent postoperative recurrence of spontaneous pneumothorax. Therefore, we used 50 mL of a 50% glucose solution for pleural coating (GPC) on an absorbable sheet intraoperatively to prevent postoperative recurrence of spontaneous pneumothorax. This is a retrospective study, and patient backgrounds are heterogeneous. We evaluated the feasibility of GPC using propensity scores to adjust for heterogeneity in their backgrounds. METHODS: Between January 2010 and December 2017, 376 patients who underwent video-assisted thoracoscopic surgery, with or without GPC, were evaluated. The GPC group consisted of 106 patients, and the non-GPC group consisted of 270. We analyzed the factors preventing postoperative recurrence of spontaneous pneumothorax by univariate analysis and Cox regression analysis with or without propensity score matching. RESULTS: Univariate analysis revealed age of 25 or older, smoking habit, no history of an ipsilateral operation, and GPC were significant factors preventing postoperative recurrence. GPC significantly prevented postoperative recurrence as shown by Cox regression analysis with propensity score matching (hazard ratio, 0.15; p = 0.014) and the inverse-probability of treatment weighted method (hazard ratio, 0.23; p = 0.0038). CONCLUSIONS: Intraoperative GPC significantly reduced the postoperative recurrence rate of spontaneous pneumothorax.
BACKGROUND: Video-assisted thoracoscopic surgery is the standard procedure for treatment of spontaneous pneumothorax. However, postoperative recurrence is relatively common even if an absorbable covering sheet is used for reinforcement of the visceral pleura. Injection of a high concentration glucose solution to the thoracic cavity was recently reported to be effective in stopping postoperative air leakage or as a prophylactic procedure to prevent postoperative recurrence of spontaneous pneumothorax. Therefore, we used 50 mL of a 50% glucose solution for pleural coating (GPC) on an absorbable sheet intraoperatively to prevent postoperative recurrence of spontaneous pneumothorax. This is a retrospective study, and patient backgrounds are heterogeneous. We evaluated the feasibility of GPC using propensity scores to adjust for heterogeneity in their backgrounds. METHODS: Between January 2010 and December 2017, 376 patients who underwent video-assisted thoracoscopic surgery, with or without GPC, were evaluated. The GPC group consisted of 106 patients, and the non-GPC group consisted of 270. We analyzed the factors preventing postoperative recurrence of spontaneous pneumothorax by univariate analysis and Cox regression analysis with or without propensity score matching. RESULTS: Univariate analysis revealed age of 25 or older, smoking habit, no history of an ipsilateral operation, and GPC were significant factors preventing postoperative recurrence. GPC significantly prevented postoperative recurrence as shown by Cox regression analysis with propensity score matching (hazard ratio, 0.15; p = 0.014) and the inverse-probability of treatment weighted method (hazard ratio, 0.23; p = 0.0038). CONCLUSIONS: Intraoperative GPC significantly reduced the postoperative recurrence rate of spontaneous pneumothorax.