Mortality and Prognostic Factors for Spontaneous Pneumothorax in Older Adults: A Retrospective Study

Abstract Background Spontaneous pneumothorax occurs predominantly in young males and older adults, in whom it is often secondary to chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILDs) and can be refractory and fatal. We aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. Methods We retrospectively studied patients with pneumothorax aged ≥ 65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from the medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. Results A total of 239 patients were included (median age, 78 years; 203 males and 36 females). Thirty-six patients (15%) died during hospitalisation, respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases), higher than previous reports (11%). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. Cox proportional hazard regression analyses for ADL, CCI, and concomitant pneumonia showed that concomitant pneumonia was the only independent predictor of death during hospitalisation (log-rank, p = 0.005). Conclusion Although COPD and ILDs are generally considered as mortality risks for pneumothorax, this study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.