Small-bore chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax.

INTRODUCTION The aim of this study was to compare the efficacy and complications of surgical (large-bore) chest tube drainage with smaller and less invasive chest tubes in the treatment of non-traumatic pneumothorax (PT).  MATERIAL AND METHODS This was a retrospective study of 104 cases (94 patients) of non-traumatic PT treated with chest tubes - either by pulmonary physicians (daytime and weekdays) using small-bore chest tubes, or by orthopaedic surgeons (remaining time slots) using large-bore chest tubes.  RESULTS A total of 62 had primary spontaneous PT, 30 had secondary spontaneous PT and 12 had iatrogenic PT. A total of 62 patients were treated with large-bore (20-28 Fr) chest tubes placed with traditional thoracotomy, 42 patients were treated by a pulmonary physician, and in 30 of these cases a True-Close thoracic vent (11-13 Fr) was inserted. Patients treated with surgical chest tubes were comparable with patients treated with smaller chest tubes in terms of demographic data and type and size of PT. Compared with patients treated with smaller chest tubes, patients with surgical large-bore tubes had more complications (27.4% versus 9.5%; p = 0.026), a lower success rate (56.5% versus 85.7%; p = 0.002), and longer duration of chest tube (8.3 versus 4.9 days; p = 0.001) and of hospitalisation (11.8 versus 6.9 days; p = 0.004).  CONCLUSION We found small chest tubes to be superior to large-bore chest tubes with regard to short-term outcomes in the treatment of non-traumatic PT.  FUNDING not relevant. TRIAL REGISTRATION The project was approved by the Danish Data Protection Agency, file no. 2012-41-0554.