Abstract
Background: Aim of the study was to assess the results of surgery for secondary spontaneous pneumothorax
(SSP) in the elderly with COPD at Shanghai Pulmonary Disease Hospital. Methods: From 1 January 1993 to 30 June 2007, the operation for SSP was performed in 107 elderly
patients (≥ 60y) with COPD. All patient data was reviewed retrospectively. Results: Morbidity was 25.2 % and mortality was 4.7 %. The total effective rate of intrapleural
injection of human fibrinogen for the treatment of postoperative persistent air leaks
was 86.7 %. Multivariate analyses of postoperative air leaks suggest that patients
undergoing pleurodesis (OR 0.189, 95 % CI 0.045–0.790, p = 0.022) have a decreased risk of postoperative air leaks. Multivariate analyses
of postoperative complications suggest that patients with higher PaCO2 (OR 0.890, 95 % CI 0.814–0.973, p = 0.011) have an increased risk and patients undergoing pleurodesis (OR 4.319, 95 %
CI 1.398–13.349, p = 0.011) have a decreased risk. Conclusions: Surgical intervention is recommended in selected elderly COPD patients with SSP,
with hypercapnia known as an operative contraindication. Additionally, surgery offers
the advantage of intraoperative pleurodesis for the prevention of prolonged postoperative
air leaks, while intrapleural injection of human fibrinogen is an effective procedure
in the treatment of air leaks.
Key words
pneumothorax - elderly - surgery
References
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