| Summary: | 碩士 === 中國醫藥學院 === 醫務管理研究所 === 91 === The objective of this study is to identify the risk factors of recurrence for primary spontaneous pneumothorax in Taiwan and to establish an appropriate model to predict the probability of recurrence in order to assist clinical management. From 1995, the beginning year of national health insurance, to the year of 2000, retrospective data based on chart review and telephone interview were collected from 600 cases of first-time primary spontaneous pneumothorax in two teaching center hospitals and two regional hospitals located at northern, central and southern Taiwan respectively. Data were analyzed using logistic regression and CHAID statistical methods.
Among the thirteen independent variables, six risk factors are significantly associated with the recurrence of spontaneous pneumothorax. They are the body mass index, activity during the onset of spontaneous pneumothorax, the first-time treatment modality, occupation, smoking, and the season (p<0.05). Moreover, CHAID method revealed that the first-time treatment modality, occupation, age, size of pneumothorax on the chest X-ray and activity during the onset of spontaneous pneumothorax are the five risk factors to significantly predict the recurrence of spontaneous pneumothorax.
Among the 600 patients of this study, 255 (42.5%) patients have recurrence. The first-time treatment modality is the most significant variable. One hundred and fifty-seven patients (52.86%) treated by chest tube for the first time of spontaneous pneumothorax had recurred. Forty-one patients (20.5%) developed recurrent pneumothorax after receiving VATS therapy, while recurrence ensued in 7 patients (16.67%) if thoracotomy procedure was applied. Conservative treatment with observation approach led to recurrence in 50 patients (81.97%). Therefore, the chance of recurrence of pneumothorax varied according to different management strategies with thoracotomy having least rate of recurrence followed increasingly by VATS, chest intubation and conservative measures.
The decision tree from the result of CHAID produced nine groups with recurrence rate of pneumothorax ranging from 12.59% to 97.14%. The wide range between the groups also reveals the different impact of individual predictive variables, interactions between them, and importance to evaluate the effect of the risk factors on the recurrence of spontaneous pneumothorax. Patients with chest X-ray finding of more than 20% of pneumothorax and received conservative treatment for their first episode of spontaneous pneumothorax have the highest recurrence rate of 97.14%. Conversely, patients with age more than eighteen years old and treated by VATS had the least recurrence rate of 12.59%.
This study identified the risk factors of recurrence of primary spontaneous pneumothorax in Taiwan and provided an appropriate model for prediction of recurrence of pneumothorax. This result could practically help us identify the high risk group of patients at the initial occurrence of pneumothorax based on the predictive model and treat them in a most efficient way.
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