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August 19, 2025Open Access

Risk Factors and Prediction Model for Spontaneous Pneumothorax Recurrence: A Retrospective Study of 440 Patients

QLQiaowei LinThird Affiliated Hospital of Guangzhou Medical University JLJiehuan LinLongyan University JMJun MaUniversité Paris-Sud

Key Points

The study found a 5-year recurrence rate of 31.82%, with the majority occurring within the first year, highlighting the serious nature of spontaneous pneumothorax.
Key independent risk factors include secondary spontaneous pneumothorax and smoking habits, with pack-years showing a strong association to recurrence risk.
This observational analysis utilized multivariable logistic regression to evaluate recurrence predictors among 440 patients treated at Longyan First Hospital.
The findings suggest integrating bullae morphology into prediction models may enhance risk stratification and surgical decision-making, indicating potential benefits for patient outcomes.

Abstract

Abstract Background Spontaneous pneumothorax (SP) recurrence imposes substantial clinical burdens, yet long-term risk stratification remains poorly defined. Methods This retrospective cohort study analyzed 440 SP patients treated at Longyan First Hospital (2010–2020). Multivariable logistic regression and Cox proportional hazards models identified recurrence predictors, with high-resolution computed tomography quantification of bullae characteristics (diameter/number). Model performance was evaluated using receiver operating characteristic curves. Results The 5-year recurrence rate was 31.82% (140/440), with 75.71% occurring within 1 year. Key independent risk factors: Secondary spontaneous pneumothorax (SSP vs. primary spontaneous pneumothoraxPSP: adjusted odds ratio aOR, 2.91; 95% confidence interval CI, 1.47–5.76); Smoking ≥ 5 pack-years (aOR, 3.28; P 5 cm (adjusted hazard ratio aHR, 1.77; 95% CI, 0.48–6.56) or > 5 in number (aHR, 7.01; 95% CI, 1.81–27.19); Surgical intervention (video-assisted thoracoscopic surgery VATS bullectomy with pleurodesis) reduced recurrence risk by 88% (aOR, 0.13; 95% CI, 0.04–0.42) versus conservative management. The prediction model integrating bullae morphology demonstrated significantly improved discrimination (area under the curve (AUC) = 0.832 vs. 0.797; ΔAUC = + 0.035, P = 0.001). Conclusions SSP, smoking, and bullae burden (> 5 lesions or > 5 cm diameter) are potent predictors of SP recurrence. VATS bullectomy with pleurodesis significantly mitigates risk. Quantification of bullae morphology enhances prediction accuracy, supporting its integration into risk-stratified clinical protocols to guide surgical decision-making.

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