Objective:

To evaluate the association of inflammatory indices and 30-day thoracic outcomes after surgical versus non-surgical management of spontaneous pneumothorax.

Approach:

• Study Design: Retrospective analysis of 320 spontaneous pneumothorax episodes treated between January 2017 and December 2024.

Key Findings:

• In weighted models, VATS was associated with higher post-treatment inflammatory indices (SII, PLR, NLR, WBC) but lower LMR, albumin, and hemoglobin. Fewer 30-day post-discharge thoracic complications were observed in the VATS group (13.2% vs. 28.5%, p < 0.001). Patients undergoing VATS had a longer median hospital stay (5.00 days vs. 3.00 days, p < 0.001) and more frequent antibiotic use (26.2% vs. 7.7%, p < 0.001). In weighted models, VATS was associated with a lower risk of 30-day post-discharge thoracic complications (OR = 0.38, 95% CI = 0.21–0.71, p = 0.002) and longer hospital stay (β = 1.91 days, 95% CI = 0.34–3.49, p = 0.017).

Interpretation:

Elevated post-treatment inflammatory biomarkers after surgery may reflect surgical stress rather than infection alone.

Limitations:

• Retrospective design may introduce selection bias.
• Treatment allocation was not random, necessitating statistical adjustments.

Conclusion:

VATS is associated with fewer 30-day post-discharge thoracic complications but longer hospitalization in spontaneous pneumothorax.