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Journals / Cerrahi Sanatlar Dergisi / 2026 / Cilt: 19

Tube thoracostomy versus conservative management for acute spontaneous pneumothorax: A systematic evidence synthesis and clinical outcomes analysis

Akut spontan pnömotoraks için konservatif tedaviye karşı tüp torakostomi: Sistematik kanıt sentezi ve klinik sonuçlar analizi

Mehmet Necmeddin Sutaşır(İSTANBUL ŞİŞLİ HAMİDİYE ETFAL SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ)0000-0001-6472-5092
Pages
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Publication Date
2026-04-01
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

In conclusion, Although emergency department tube thoracostomy improves short-term treatment success in acute spontaneous pneumothorax, it does not provide distinct advantages regarding long-term recurrence rates.

📌 3 Key Takeaways

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Objective & Hypothesis:To evaluate the clinical efficacy and safety of emergency department tube thoracostomy compared to conservative or elective treatment strategies in patients with acute spontaneous pneumothorax.
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Key Findings & Data:Comprehensive systematic search of PubMed, Web of Science, and Scopus databases was conducted for publications between 2014 and 2024.
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Conclusion & Impact:In conclusion, Although emergency department tube thoracostomy improves short-term treatment success in acute spontaneous pneumothorax, it does not provide distinct advantages regarding long-term recurrence rates.
🔬Design:Derleme
📍Scope:2014 Verileri
⚙️Variables:spontan pnömothorax · tüp torakostomi · acil durum yönetimi

Abstract

To evaluate the clinical efficacy and safety of emergency department tube thoracostomy compared to conservative or elective treatment strategies in patients with acute spontaneous pneumothorax. Comprehensive systematic search of PubMed, Web of Science, and Scopus databases was conducted for publications between 2014 and 2024. Seventy-seven studies involving 12,847 patients were included in the analysis following PRISMA 2020 guidelines. Statistical analysis was performed using RevMan 5.4, R, and Stata software. Evidence quality was assessed using GRADE methodology. Risk ratios (RR) with 95% confidence intervals (CI) were calculated for binary outcomes. Emergency department tube thoracostomy demonstrated significantly higher treatment success compared to conservative or elective management [RR: 1.34 (95% CI: 1.18-1.52), p<0.001]. However, no significant difference was observed in recurrence rates between groups [RR: 1.13 (95% CI: 0.94-1.35), p=0.198]. Hospital length of stay was comparable between groups (standardized mean difference: 0.21, p=0.098). Complication rates were significantly higher in the intervention group [RR: 1.27 (95% CI: 1.04-1.55), p=0.024], while mortality rates did not differ significantly [RR: 1.88 (95% CI: 0.41-8.61), p=0.410]. Moderate quality evidence was identified for all primary outcomes. In conclusion, Although emergency department tube thoracostomy improves short-term treatment success in acute spontaneous pneumothorax, it does not provide distinct advantages regarding long-term recurrence rates. Treatment decisions should be individualized, considering patient comorbidities, socioeconomic status, follow-up capacity, and patient preferences. Evidence-based clinical algorithms integrating patient-specific factors are recommended for optimal treatment selection in acute pneumothorax management.

Özet

Akut spontan pnömotoraksı olan hastalarda acil servis tüp torakostomisinin konservatif veya elektif tedavi stratejilerine kıyasla klinik etkinliğini ve güvenliğini değerlendirmek amaçlanmıştır. 2014-2024 yılları arasında yayınlanan makaleler için PubMed, Web of Science ve Scopus veritabanlarında kapsamlı bir sistematik arama yapıldı. PRISMA 2020 kılavuzlarına göre 12.847 hastayı içeren 77 çalışma analize dahil edildi. İstatistiksel analiz RevMan 5.4, R ve Stata yazılımları kullanılarak gerçekleştirildi. Kanıt kalitesi GRADE metodolojisi kullanılarak değerlendirildi. İkili sonuçlar için %95 güven aralığı (CI) ile risk oranları (RR) hesaplandı. Acil servis tüp torakostomisi, konservatif veya elektif yönetime kıyasla anlamlı derecede daha yüksek tedavi başarısı gösterdi (RR: 1,34 (%95 CI: 1,18-1,52), p<0,001). Ancak, gruplar arasında tekrarlama oranlarında anlamlı bir fark gözlenmedi (RR: 1,13 (95% CI: 0,94-1,35), p=0,198). Hastanede kalış süresi gruplar arasında karşılaştırılabilir düzeydeydi (standartlaştırılmış ortalama fark: 0,21, p=0,098). Komplikasyon oranları müdahale grubunda anlamlı derecede daha yüksekti (RR: 1,27 (95% CI: 1,04-1,55), p=0,024), ölüm oranlarında ise anlamlı bir fark yoktu (RR: 1,88 (95% CI: 0,41-8,61), p=0,410). Tüm birincil sonuçlar için orta düzeyde kanıt kalitesi belirlendi. Acil serviste tüp torakostomi, akut spontan pnömotoraks tedavisinde kısa vadeli başarıyı artırsa da, uzun vadeli tekrarlama oranları açısından belirgin bir avantaj sağlamamaktadır. Tedavi kararları, hastanın eşlik eden hastalıkları, sosyoekonomik durumu, takip kapasitesi ve hasta tercihleri dikkate alınarak bireyselleştirilmelidir. Akut pnömotoraks yönetiminde optimal tedavi seçimi için hastaya özgü faktörleri entegre eden kanıta dayalı klinik algoritmalar önerilmektedir.

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Cite This Article

Sutaşır, M. N. (2026). Tube thoracostomy versus conservative management for acute spontaneous pneumothorax: A systematic evidence synthesis and clinical outcomes analysis. Cerrahi Sanatlar Dergisi, Cilt: 19. https://doi.org/10.4717/jsa.1811029

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