Abstract Background Optimal management for first-episode primary spontaneous pneumothorax (PSP) with pulmonary blebs remains uncertain, balancing recurrence prevention against procedural costs. This study compared video-assisted thoracoscopic surgery (VATS) and chest tube drainage in terms of recurrence prevention and cost-effectiveness, incorporating sensitivity analyses to evaluate robustness across variable assumptions. Methods In a retrospective cohort (2010–2020), 245 first-episode PSP patients with computed tomography (CT)-confirmed blebs were included. Propensity score matching (1:1, caliper = 0.02) balanced baseline characteristics (age, bleb size, etc.), generating 33 matched pairs. Primary outcomes were recurrence rate and incremental cost-effectiveness ratio (ICER). Results VATS reduced 5-year recurrence rates from 48.5–12.1% (P = 0.004; absolute risk reduction ARR = 36.4%, number needed to treat NNT = 2.75) and improved recurrence-free survival (hazard ratio HR = 0.166, P 98.4% cost-effectiveness probability. Conclusions VATS reduces recurrence by 83.4% in first-episode PSP with blebs and demonstrates robust cost-effectiveness. Early surgical intervention should be considered for patients with blebs across diverse resource settings.
Qiaowei Lin (Mon,) studied this question.