Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study
Abstract Objective Surgery is one of the preferred primary treatments for primary spontaneous pneumothorax (PSP); however, postoperative recurrent pneumothorax (PORP), defined as recurrence on the same side, occurs in 3–13% of cases. While environmental factors have been implicated in PSP occurrence...
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| Language: | English |
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BMC
2025-05-01
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| Series: | Respiratory Research |
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| Online Access: | https://doi.org/10.1186/s12931-025-03254-1 |
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| author | Yu-Wei Liu Chieh-Ni Kao Chi-Chang Ho Shah-Hwa Chou Pau-Chung Chen Shu-Hung Huang |
| author_facet | Yu-Wei Liu Chieh-Ni Kao Chi-Chang Ho Shah-Hwa Chou Pau-Chung Chen Shu-Hung Huang |
| author_sort | Yu-Wei Liu |
| collection | DOAJ |
| description | Abstract Objective Surgery is one of the preferred primary treatments for primary spontaneous pneumothorax (PSP); however, postoperative recurrent pneumothorax (PORP), defined as recurrence on the same side, occurs in 3–13% of cases. While environmental factors have been implicated in PSP occurrence, their role in PORP remains unclear. This study aimed to investigate the impact of environmental factors on the onset of PSP and PORP in the same patient population. Methods Between 2009 and 2019, a total of 442 patients (aged ≤ 40 years) underwent 486 surgeries for PSP, with 43 patients (8.8%) experiencing a first PORP. Management of PORP included reoperation (29 patients), pleural drainage with chemical pleurodesis (4 patients), and conservative observation (10 patients). In this case-crossover study, the day of symptom onset for PSP and PORP was designated as the “case day.” To evaluate potential lag effects, the days leading up to symptom onset, ranging from 1 day prior (lag day 1) to 7 days prior (lag day 7), were also analyzed as “case days.” Unidirectional matched control days were selected 14–21 days before the case day (lag day 0). Results Elevated PM2.5 levels were significantly associated with PSP onset at lag day 0 and lag day 1, with increased odds observed at these time points (p = 0.04 and p = 0.02, respectively). No such association was found for PORP patients. Meteorological factors did not appear to influence PSP or PORP risk. Seasonally, both the PSP incidence and the PORP incidence were significantly greater in autumn and spring than in summer and winter (p < 0.001). Conclusion PSP and PORP demonstrate seasonal clustering, with higher incidences in autumn and spring. Elevated PM2.5 levels appear to contribute to PSP onset but not PORP, suggesting that air pollution may be a potential trigger for PSP. Further research is needed to clarify environmental influences and optimize tailored management strategies. Clinical trial number Not applicable. |
| format | Article |
| id | doaj-art-7cfe47a4b1ce4a8ebe37e4b4defd8a75 |
| institution | OA Journals |
| issn | 1465-993X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj-art-7cfe47a4b1ce4a8ebe37e4b4defd8a752025-08-20T02:15:11ZengBMCRespiratory Research1465-993X2025-05-0126111110.1186/s12931-025-03254-1Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover studyYu-Wei Liu0Chieh-Ni Kao1Chi-Chang Ho2Shah-Hwa Chou3Pau-Chung Chen4Shu-Hung Huang5PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research InstitutesDivision of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityInstitute of Environmental and Occupational Health Sciences, National Taiwan University College of Public HealthDivision of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical UniversityInstitute of Environmental and Occupational Health Sciences, National Taiwan University College of Public HealthDepartment of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical UniversityAbstract Objective Surgery is one of the preferred primary treatments for primary spontaneous pneumothorax (PSP); however, postoperative recurrent pneumothorax (PORP), defined as recurrence on the same side, occurs in 3–13% of cases. While environmental factors have been implicated in PSP occurrence, their role in PORP remains unclear. This study aimed to investigate the impact of environmental factors on the onset of PSP and PORP in the same patient population. Methods Between 2009 and 2019, a total of 442 patients (aged ≤ 40 years) underwent 486 surgeries for PSP, with 43 patients (8.8%) experiencing a first PORP. Management of PORP included reoperation (29 patients), pleural drainage with chemical pleurodesis (4 patients), and conservative observation (10 patients). In this case-crossover study, the day of symptom onset for PSP and PORP was designated as the “case day.” To evaluate potential lag effects, the days leading up to symptom onset, ranging from 1 day prior (lag day 1) to 7 days prior (lag day 7), were also analyzed as “case days.” Unidirectional matched control days were selected 14–21 days before the case day (lag day 0). Results Elevated PM2.5 levels were significantly associated with PSP onset at lag day 0 and lag day 1, with increased odds observed at these time points (p = 0.04 and p = 0.02, respectively). No such association was found for PORP patients. Meteorological factors did not appear to influence PSP or PORP risk. Seasonally, both the PSP incidence and the PORP incidence were significantly greater in autumn and spring than in summer and winter (p < 0.001). Conclusion PSP and PORP demonstrate seasonal clustering, with higher incidences in autumn and spring. Elevated PM2.5 levels appear to contribute to PSP onset but not PORP, suggesting that air pollution may be a potential trigger for PSP. Further research is needed to clarify environmental influences and optimize tailored management strategies. Clinical trial number Not applicable.https://doi.org/10.1186/s12931-025-03254-1Primary spontaneous pneumothorax (PSP)Postoperative recurrent pneumothorax (PORP)Environmental factorsMeteorologyAir pollutionSeasonal variations |
| spellingShingle | Yu-Wei Liu Chieh-Ni Kao Chi-Chang Ho Shah-Hwa Chou Pau-Chung Chen Shu-Hung Huang Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study Respiratory Research Primary spontaneous pneumothorax (PSP) Postoperative recurrent pneumothorax (PORP) Environmental factors Meteorology Air pollution Seasonal variations |
| title | Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study |
| title_full | Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study |
| title_fullStr | Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study |
| title_full_unstemmed | Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study |
| title_short | Effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax: a case-crossover study |
| title_sort | effect of environmental factors on postoperative recurrent primary spontaneous pneumothorax a case crossover study |
| topic | Primary spontaneous pneumothorax (PSP) Postoperative recurrent pneumothorax (PORP) Environmental factors Meteorology Air pollution Seasonal variations |
| url | https://doi.org/10.1186/s12931-025-03254-1 |
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