Treatment methods and recurrence rates in primary spontaneous pneumothorax: a 10-year retrospective study.

Aim: Primary spontaneous pneumothorax (PSP) predominantly affects young individuals and presents with variable treatment outcomes and considerable recurrence rates. Understanding the relationship between treatment approach and recurrence is essential for guiding clinical decision-making. The aim of this study was to evaluate demographic characteristics, treatment modalities, and recurrence rates in patients with PSP. Methods: This single-center, retrospective study included patients diagnosed with PSP between January 2014 and December 2023. Recurrence rates following treatment were analyzed. Results: A total of 314 patients (median age 28 years; 93.0% male) were included. Tube thoracostomy was the initial treatment in 250 patients (79.6%). Recurrence occurred in 78 patients (24.8%), with higher rates following tube thoracostomy (28.0%) compared to oxygen therapy (17.8%). No recurrence was observed after initial video-assisted thoracoscopic surgery (VATS). In recurrent cases, 44.9% underwent VATS, 25.6% tube thoracostomy, and 29.5% oxygen therapy. Treatment choice and smoking status showed significant associations (p<0.001 for the first episode and p=0.007 for the second episode). Notably, all patients who underwent VATS were smokers. Conclusions: VATS performed during the first pneumothorax episode in selected patients prevents recurrence. The feasibility of VATS as the first treatment option in selected patients should be further investigated in larger series.