Analysis of the incidence and influencing factors of pneumothorax in elderly patients undergoing CT-guided percutaneous lung biopsy
Objective To investigate the incidence and influencing factors of pneumothorax in elderly patients(aged ≥65 years)undergoing CT-guided percutaneous lung biopsy(PLB).Methods A prospective cohort study was conducted,enrolling elderly patients who underwent CT-guided PLB at Beijing Hospital from January 2017 to December 2023.Pneumothorax occurrence was assessed through two CT scans performed immediately post-procedure and at 48 hours post-PLB.Based on pneumothorax status,patients were categorized into a pneumothorax group and a non-pneumothorax group.Baseline clinical and procedural data were compared between the two groups,and multivariate logistic regression analyses were conducted to identify factors associated with pneumothorax.Results Among the 647 elderly patients who underwent PLB,152 cases(23.5％,152/647)developed pneumothorax,with 101 cases(15.6％)presenting with minor pneumothorax and 51 cases(7.9％)with major pneumothorax.Compared with the non-pneumothorax group,patients in the pneumothorax group had a higher incidence of chronic obstructive pulmonary disease(COPD),higher frailty proportion,smaller lesions,lesions located further from the chest wall,more frequent bronchial involvement,and a higher rate of puncture depth ≥5 cm(all P＜0.05).Multivariate logistic regression analysis revealed the following as significant risk factors for minor pneumothorax:COPD(OR=1.256,95％CI:1.014-1.558,P=0.033),lesion size ≤2 cm(OR=1.345,95％CI:1.075-1.659,P=0.022),lesion-to-chest-wall distance ≥ 2 cm(OR=1.372,95％CI:1.105-1.703,P=0.007),presence of pulmonary bullae or emphysema(OR=1.524,95％CI:1.223-1.899,P＜0.001),ground-glass opacity density(OR=1.313,95％CI:1.072-1.839,P=0.014),bronchial involvement(OR=1.211,95％CI:1.047-1.694,P=0.038),and needle insertion depth ≥ 5 cm(OR=1.312,95％CI:1.024-1.749,P=0.038).For major pneumothorax,significant risk factors included age(OR=1.286,95％CI:1.021-1.819,P=0.041),COPD(OR=1.248,95％CI:1.098-1.753,P=0.035),heart failure(OR=1.312,95％CI:1.027-1.956,P=0.042),frailty(OR=1.301,95％CI:1.063-1.981,P=0.036),lesion size≤2 cm(OR=1.345,95％CI:1.040-1.872,P=0.039),lesion-to-chest-wall distance ≥ 2 cm(OR=1.482,95％CI:1.116-1.738,P=0.032),presence of bullae or emphysema(OR=1.705,95％CI:1.316-2.431,P=0.024),and puncture depth ≥ 5 cm(OR=1.343,95％CI:1.058-1.763,P=0.037).Conclusions Elderly patients undergoing CT-guided PLB have a high risk of pneumothorax.Personalized predictive strategies are necessary to reduce the risk of pneumothorax,particularly major pneumothorax.
万方数据
维普
