{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:18:36Z","timestamp":1774621116045,"version":"3.50.1"},"reference-count":48,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Several studies previously investigated the risk factors for post-operative recurrence of primary spontaneous pneumothorax (PSP), with conflicting results. Identification of patients at greater risk of recurrence may help optimize therapeutic strategies. The aim of this study is to identify potential predictors of post-operative recurrence of PSP and compare our results with the available literature. Methods: We retrospectively evaluated all patients who underwent surgery for PSP at our institution between January 2005 and December 2022. We analyzed data on patient characteristics, surgical details, method of pleurodesis and perioperative outcomes and used Cox regression analysis to identify predictors post-operative ipsilateral recurrence. Results: 226 patients were included in our study, of which 29 (12.8%) developed an ipsilateral recurrence of pneumothorax. A positive history of previous contralateral episodes (37.9% vs. 19.3%, p = 0.03) and the positioning of larger chest drains after the procedure (65.5% vs. 44.8%, p = 0.032) were more frequent in the recurrence group. At multivariable regression analysis, a history of previous contralateral pneumothorax was found to be the only independent predictive factor of pneumothorax recurrence (HR 2.16, 95% C.I. 1.001\u20134.662, p = 0.049). Conclusions: Previous contralateral pneumothorax is a risk factor for the development of post-operative recurrences.<\/jats:p>","DOI":"10.3390\/jcm15072557","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T12:45:53Z","timestamp":1774615553000},"page":"2557","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary Spontaneous Pneumothorax: Results of Surgical Treatment and Analysis of Risk Factors for Post-Operative Recurrence\u2014A Retrospective Cohort Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1020-6862","authenticated-orcid":false,"given":"Serena","family":"Zanardo","sequence":"first","affiliation":[{"name":"Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8955-6053","authenticated-orcid":false,"given":"Francesco","family":"Londero","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5052-2302","authenticated-orcid":false,"given":"Yvonne","family":"Beorchia","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and Evaluative Epidemiology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8775-2640","authenticated-orcid":false,"given":"Luigi","family":"Castriotta","sequence":"additional","affiliation":[{"name":"Institute of Hygiene and Evaluative Epidemiology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"De Franceschi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1905-9099","authenticated-orcid":false,"given":"William","family":"Grossi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Masullo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Zuin","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1055\/s-2001-18801","article-title":"Pneumothorax","volume":"22","author":"Baumann","year":"2001","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Amer, K. (2019). Pneumothorax, IntechOpen.","DOI":"10.5772\/intechopen.73885"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1440-1843.2004.00577.x","article-title":"Pneumothorax","volume":"9","author":"Baumann","year":"2004","journal-title":"Respirology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1007\/s00268-016-3508-z","article-title":"Recurrent Primary Spontaneous Pneumothorax is Common Following Chest Tube and Conservative Treatment","volume":"40","author":"Olesen","year":"2016","journal-title":"World J. Surg."},{"key":"ref_5","first-page":"2729548","article-title":"Primary Spontaneous Pneumothorax Admitted in Emergency Unit: Does First Episode Differ from Recurrence? A Cross-Sectional Study","volume":"2017","author":"Kepka","year":"2017","journal-title":"Can. Respir. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1821","DOI":"10.1183\/09031936.96.09091821","article-title":"Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax","volume":"9","author":"Schramel","year":"1996","journal-title":"Eur. Respir. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/S1010-7940(01)00679-0","article-title":"Is video-assisted thoracic surgery justified at first spontaneous pneumothorax?","volume":"20","author":"Torresini","year":"2001","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/crj.12990","article-title":"New insights and improved strategies for the management of primary spontaneous pneumothorax","volume":"13","author":"Plojoux","year":"2019","journal-title":"Clin. Respir. J."},{"key":"ref_9","first-page":"144","article-title":"Pneumothorax","volume":"32","author":"Desai","year":"2019","journal-title":"Pneumon"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/ans.14713","article-title":"Management of primary spontaneous pneumothorax: A review","volume":"89","author":"Wong","year":"2019","journal-title":"ANZ J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1510\/icvts.2009.216473","article-title":"In patients with first-episode primary spontaneous pneumothorax is video-assisted thoracoscopic surgery superior to tube thoracostomy alone in terms of time to resolution of pneumothorax and incidence of recurrence?","volume":"9","author":"Chambers","year":"2009","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1089\/lap.2019.0742","article-title":"Management of the Pediatric Spontaneous Pneumothorax: The Role of Video-Assisted Thoracoscopic Surgery","volume":"30","author":"Gudelj","year":"2020","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5582\/bst.2015.01070","article-title":"Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery","volume":"9","author":"Huang","year":"2015","journal-title":"Biosci. Trends"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.pulmoe.2020.06.003","article-title":"Recurrence of primary spontaneous pneumothorax: Associated factors","volume":"28","author":"Ferreiro","year":"2022","journal-title":"Pulmonology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1800864","DOI":"10.1183\/13993003.00864-2018","article-title":"Recurrence rates in primary spontaneous pneumothorax: A systematic review and meta-analysis","volume":"52","author":"Walker","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration","volume":"18","author":"Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"key":"ref_17","unstructured":"Societ\u00e0 Italiana di Chirurgia Toracica (2026, February 26). Pneumotorace Spontaneo Primitivo. Linee Guida della Societ\u00e0 Italiana di Chirurgia Toracica. Available online: https:\/\/www.iss.it\/-\/snlg-pneumotorace-spontaneo-primitivo."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Woo, W., Kim, C.H., Kim, B.J., Song, S.H., Moon, D.H., Kang, D.Y., and Lee, S. (2021). Early Postoperative Pneumothorax Might Not Be \u2018True\u2019 Recurrence. J. Clin. Med., 10.","DOI":"10.3390\/jcm10235687"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.21037\/jtd-20-3257","article-title":"Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: A retrospective analysis","volume":"13","author":"Brophy","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_20","first-page":"6014967","article-title":"Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality","volume":"2017","author":"Onuki","year":"2017","journal-title":"Can. Respir. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and Cox regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/s00595-016-1452-z","article-title":"Outcome and risk factors of recurrence after thoracoscopic bullectomy in young adults with primary spontaneous pneumothorax","volume":"47","author":"Nakayama","year":"2017","journal-title":"Surg. Today"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ejcts.2008.03.049","article-title":"Residual apical space following surgery for pneumothorax increases the risk of recurrence","volume":"34","author":"Gaunt","year":"2008","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1016\/j.jpedsurg.2008.08.041","article-title":"Video-assisted thoracic surgery for primary spontaneous pneumothorax in children: Is there an optimal technique?","volume":"43","author":"Bialas","year":"2008","journal-title":"J. Pediatr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1378\/chest.92.6.1009","article-title":"Smoking and the increased risk of contracting spontaneous pneumothorax","volume":"92","author":"Bense","year":"1987","journal-title":"Chest"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1164\/ajrccm\/147.6_Pt_1.1537","article-title":"Inactivation of alpha 1-proteinase inhibitor by alveolar inflammatory cells from smoking patients with or without emphysema","volume":"147","author":"Wallaert","year":"1993","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1183\/09031936.93.04030324","article-title":"Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax","volume":"4","author":"Lippert","year":"1991","journal-title":"Eur. Respir. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jtcvs.2008.12.019","article-title":"The impact of smoking in primary spontaneous pneumothorax","volume":"138","author":"Cheng","year":"2009","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/1749-8090-7-112","article-title":"What factors predict recurrence of a spontaneous pneumothorax?","volume":"7","author":"Uramoto","year":"2012","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1093\/icvts\/ivv022","article-title":"Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery","volume":"20","author":"Imperatori","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/icvts\/ivaa064","article-title":"Analysis of pneumothorax recurrence risk factors in 843 patients who underwent videothoracoscopy for primary spontaneous pneumothorax: Results of a multicentric study","volume":"31","author":"Cattoni","year":"2020","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"3696","DOI":"10.21037\/jtd-24-175","article-title":"Incidence and risk factors for recurrent primary spontaneous pneumothorax after video-assisted thoracoscopic surgery: A systematic review and meta-analysis","volume":"16","author":"Huang","year":"2024","journal-title":"J. Thorac. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/ejcts\/ezaa054","article-title":"Fate of contralateral asymptomatic bullae in patients with primary spontaneous pneumothorax","volume":"58","author":"Jang","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/j.jtcvs.2019.08.009","article-title":"Simultaneous bilateral thoracoscopic blebs excision reduces contralateral recurrence in patients undergoing operation for ipsilateral primary spontaneous pneumothorax","volume":"159","author":"Liu","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"393","DOI":"10.5090\/kjtcs.2015.48.6.393","article-title":"Outcomes of Contralateral Bullae in Primary Spontaneous Pneumothorax","volume":"48","author":"Noh","year":"2015","journal-title":"Korean J. Thorac. Cardiovasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13019-019-0848-4","article-title":"Neo-generation of neogenetic bullae after surgery for spontaneous pneumothorax in young adults: A prospective study","volume":"14","author":"Onuki","year":"2019","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3783","DOI":"10.21037\/jtd-23-257","article-title":"Risk factors for the recurrence of primary spontaneous pneumothorax after video-assisted thoracoscopic surgery in patients younger than 40 years","volume":"15","author":"Shigenobu","year":"2023","journal-title":"J. Thorac. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.chest.2022.05.001","article-title":"Natural History of Contralateral Bullae\/Blebs After Ipsilateral Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: A Retrospective Cohort Study","volume":"162","author":"Jeong","year":"2022","journal-title":"Chest"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1111\/ans.18552","article-title":"Spontaneous pneumothorax rates following video-assisted thoracoscopic talc pleurodesis with or without resection of macroscopic bullous disease","volume":"93","author":"Kennedy","year":"2023","journal-title":"ANZ J. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.jtcvs.2009.07.047","article-title":"Is prophylactic treatment of contralateral blebs in patients with primary spontaneous pneumothorax indicated?","volume":"139","author":"Chou","year":"2010","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1378\/chest.06-2772","article-title":"Contralateral recurrence of primary spontaneous pneumothorax","volume":"132","author":"Huang","year":"2007","journal-title":"Chest"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1046\/j.1445-5994.2003.00467.x","article-title":"Comparison of large- and small-bore intercostal catheters in the management of spontaneous pneumothorax","volume":"33","author":"Vedam","year":"2003","journal-title":"Intern. Med. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.ajem.2006.04.006","article-title":"Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adults","volume":"24","author":"Tsai","year":"2006","journal-title":"Am. J. Emerg. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/ejop.ejop_2_18","article-title":"Chest drain size: Does it matter?","volume":"20","author":"McCracken","year":"2018","journal-title":"Eurasian J. Pulmonol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s13665-017-0162-3","article-title":"Chest Drain Size: The Debate Continues","volume":"6","author":"Hallifax","year":"2017","journal-title":"Curr. Pulmonol. Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jfma.2012.12.016","article-title":"Chemical pleurodesis for prolonged postoperative air leak in primary spontaneous pneumothorax","volume":"113","author":"How","year":"2014","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1579-2129(06)60118-3","article-title":"Effectiveness and complications of video-assisted surgery for primary spontaneous pneumothorax","volume":"42","author":"Moradiellos","year":"2006","journal-title":"Arch. Bronconeumol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/0003-4975(94)92210-1","article-title":"Video-assisted thoracoscopic surgery versus thoracotomy for spontaneous pneumothorax","volume":"58","author":"Waller","year":"1994","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2557\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:16:12Z","timestamp":1774617372000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":48,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072557"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072557","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]}}}