Should we abandon the simple aspiration in favour of chest tube drainage in the management of spontaneous pneumothorax? A systematic review and meta-analysis

Backgrounds Following the latest studies, the choice between chest tube drainage and simple aspiration remains debated in the treatment of spontaneous pneumothorax. The aim of this study was to compare the efficacy between SA and CTD in treatment of spontaneous pneumothorax in adults in a systematic review and meta-analysis. Methods Literature research was conducted with Medline, Embase and Central databases from inception to march 2025. The target population is adults presenting a SP managed by SA or CTD among randomized control trials and retrospective comparative studies. The RoB-2 and NOS was carried out for the quality assessment of studies. A meta-analysis was conducted with inverse variance and a random effect model. Results 19 studies were included in the meta-analysis. The results of meta-analysis comparing SA vs. CTD were as follows: immediate success OR = 0.42 (95% CI= [0.16, 1.09], p = 0.07), adverse effect occurrence OR = 0.22 (95% CI=[0.08, 0.61], p = 0.004), length of hospitalization MD = -2.59 (95% CI=[-3.57, -1.61], p < 0.001), pain score MD=-1.34 (95% CI=[-1.74, -0.95], p < 0.001). Conclusion This meta-analysis shows no difference in the efficacy between SA and CTD in the treatment of SP, especially for PSP. However, the additional benefits of SA over CTD in clinical patient management support prioritizing this strategy, in line with international guideline recommendations.