Spontaneous Pneumothorax

Abstract

Background: Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital diagnosis and treatment.

Methods: Data from all patients aged 10 or older who were hospitalized in the period 2011-2015 with a main discharge diagnosis of pneumothorax of neither traumatic nor iatrogenic origin were retrieved from the German Federal Statistical Office. Because of their source, all data were based on case numbers rather than patient numbers.

Results: During the period of the study, there were 52 738 admissions with the main diagnosis of spontaneous pneumothorax, corresponding to an annual frequency of hospitalization of 14.3 per 100 000 persons per year (95% confidence interval, 14.0 to 14.5). Men were more frequently affected than women. The lethality and in-hospital mortality of this condition (≤ 0.08% and ≤ 0.3%, respectively) were low among persons aged 15 to 45, but markedly higher in persons over age 90 (9.4% and 15.9%, respectively). The frequency of accompanying pulmonary diagnoses also rose with age. Computerized tomography (CT) was performed in 38.9-54.6% of hospitalizations, depending on age. Monitoring on an intensive care unit was carried out in 36% of cases. More than one-quarter of cases involved surgical treatment.

Conclusion: The danger to life and the likelihood of an accompanying pulmonary diagnosis are both low up to age 45. Treatment on an intensive care unit and computerized tomography of the chest should be performed only for strict indications in patients under age 45. The pathophysiological basis of the differing patterns of illness depending on age and sex requires further investigation.

Figure 1

Age- and sex-differentiated number of inpatient cases with pneumothorax (J93) as the primary diagnosis during the period from 2011 to 2015. (Age cohorts from 10–15 to 90 years and older)

Figure 2

Percentage share of pneumothorax deaths in the total number of inpatient cases with pneumothorax as the primary diagnosis 2011–2015 (in-hospital mortality), age-differentiated (age cohorts from 10–15 to 90 years and older)

Figure 3

Number of primary diagnoses of pneumothorax (J93) and number of aggregated pulmonary secondary diagnoses of COPD (J44), interstitial pulmonary disease (J84), pneumonia (J18), lung cancer (C34), 2011–2015, age-differentiated (age cohorts from age 10–15 to 90 years and older) SD, secondary diagnosis