Pleural tenting as an effective adjunct in patients with pneumothorax secondary to emphysema evaluated with computed tomography scan

Background: The efficacy of thoracoscopic blebectomy and pleurodesis for secondary spontaneous pneumothorax (SSP) is often attenuated by diffuse emphysematous parenchyma. In this study, we reviewed our surgical results of pleural tenting and its association with preoperative chest computed tomography (CT) in patients with SSP. Methods: From September 2005 to December 2014, there were 96 surgeries on 84 patients with SSP due to pulmonary emphysema. The data was collected on age, sex, smoking status, preoperative chest CT scan image, surgical procedure, blood loss, operative time, duration of tube thoracostomy, and hospital stay. We used Goddard score, a visual scoring system, to evaluate the severity of emphysema. Multivariable regression and logistic regression were performed to identify the factors associated with outcomes. Results: The patients were separated according to the Goddard score, where patients with Goddard score ≤2 were in group 1 and those with Goddard score > 2 in group 2. Goddard score and pleural tenting both significantly influenced the duration of tube thoracostomy in group 2 (P=0.026 and 0.003) but not in group 1. The Goddard score had significant impact on recurrence (P=0.019, OR =2.525), the risk of secondary procedure (P=0.033, OR =4.754), and complication (P=0.002, OR =2.913). Pleural tenting was found to decrease the risk of secondary procedure (P=0.034, OR =0.059). For complication and mortality rate, age was an important risk factor (P < 0.001, OR =1.110 and P=0.028, OR =1.146). Conclusions: In patients with moderate and severe emphysema, pleural tenting significantly reduced the duration of tube thoracostomy and the risk of secondary procedure.