Background: Spontaneous pneumothorax (SP) and pneumomediastinum (PM) have emerged as significant complications in patients with COVID-19, affecting both ventilated and non-ventilated individuals. These complications pose clinical management challenges, with surgical intervention often reserved for persistent or complicated cases. Objective: The objective of the study is to systematically review observational studies describing the incidence, clinical characteristics, and management strategies, with a focus on the role and timing of surgical intervention in COVID-19-associated SP and PM. Methods: We conducted a comprehensive literature search of PubMed, Embase, and Scopus from January 2020 to April 2025 for cohort and prospective studies reporting SP/PM in COVID-19 patients. Case reports and studies without management details were excluded. Data on demographics, clinical presentation, management, surgical indications, timing, and outcomes were extracted and analyzed. Results: Twelve observational studies, including 368 patients, were reviewed. SP occurred in 26%, PM in 19%, with 13% exhibiting both. Conservative management sufficed in 70% of cases, whereas 30% required chest tube drainage. Surgical intervention was performed in 16%, predominantly for persistent air leaks and recurrent pneumothorax. Video-assisted thoracoscopic surgery was the main surgical modality. Early surgical intervention (within 7 days) correlated with improved outcomes, including reduced hospital stay and lower recurrence rates. Conclusion: Surgical intervention plays a critical role in managing complicated SP and PM in COVID-19 patients. Early minimally invasive surgery is associated with better outcomes. Further prospective studies are necessary to optimize surgical timing and patient selection.
Pai et al. (Sat,) studied this question.