Variation in perioperative care for recurrent primary spontaneous pneumothorax: a Dutch survey

Surgery is the recommended treatment for patients with recurrent primary spontaneous pneumothorax (PSP) or persistent air leakage after conservative treatment. Although frequently performed, there is no consensus about optimal perioperative care. Also, great variability in management has been demonstrated among paediatric populations. We conducted an online survey among Dutch (cardio)thoracic surgeons to analyse the variation in treatment and perioperative care. This survey was based on a clinical case of an adult male with recurrent PSP. Forty-five Dutch (cardio)thoracic surgeons completed the survey, comprising a response rate of 70% of all hospitals in the Netherlands. Only 62% of the respondents routinely perform a preoperative chest computed tomography scan. Video-assisted thoracoscopic surgery is used in 100% of the cases with pleurectomy as the preferred pleurodesis technique in 89%. Regarding chest tube policy, most surgeons (69%) leave the tube in place for a fixed number of days (variable range of 1-5) and 31% remove the chest tube based on absence of air leakage only. The most applied analgesic technique is thoracic epidural analgesia (78%). Our findings expose considerable variability in perioperative care for adults with PSP. Optimizing and standardizing chest tube policy and pain management may enhance the efficacy of perioperative care by potentially reducing length of stay, costs and variability.