Disposition

After successful emergency treatment of a spontaneous pneumothorax, referral or consultation regarding definitive management with pleurodesis with or without VAT or thoracotomy should be done. Some authors recommend VAT for the first spontaneous pneumothorax due to the relative high rate of pneumothorax recurrence, lower overall cost, and success rate of the procedure, but this seems overly aggressive. 17 Recurrence after VAT requires open thoracotomy with pleurectomy or pleural scarification.8

Recurrence of the pneumothorax is the major long-term complication and the reason that all patients with spontaneous pneumothorax require referral for potential definitive therapy. Primary spontaneous pneumothorax recurs in about 30 to 40 percent and is independent of the method chosen to remove the intrapleural air. 6 Two-thirds of such cases occur within the first year.6 Smoking cessation reduces this risk by half.2 Secondary spontaneous pneumothorax recurs in 40 to 50 percent of patients.

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