The aim of this study is to compare the recurrence rates with different modalities used as first-line treatment for first-episode primary spontaneous pneumothorax, and investigated the risk factors for recurrence. We retrospectively reviewed consecutive patients under 60 years of age who were treated for a first episode of primary spontaneous pneumothorax between May 1996 and May 2016 at our hospital. The patients were divided into 6 groups according to the treatment received. A total of 667 patients with 890 episodes of primary spontaneous pneumothorax were included in the analysis. The median follow-up period was 64.5 months. The recurrence rate in the 6 groups was as follows: observation, 52.5 (21/40); chest tube drainage, 32.6 (84/258); aspiration, 100 (42/42); axillary thoracotomy, 8.8 (9/102); 2-port video-assisted thoracoscopic surgery (VATS), 6.0 (7/117); and 3-port VATS, 10.6 (11/108). The recurrence rate was higher in non-surgery groups than in surgery groups (147/340 vs 27/327, P < 0.01). Pneumothorax size (odds ratio OR = 0.252, P = 0.017) and duration of chest tube drainage (OR = 0.687, P = 0.001) were independent risk factors for ipsilateral recurrence. In the management of first-episode primary spontaneous pneumothorax, the recurrence rate was higher in patients who were treated with conservative procedures as compared with surgery. Pneumothorax size and duration of chest tube drainage were risk factors for recurrence after initial treatment.
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