Abstract
Aim
Secondary spontaneous pneumothorax (SSP) most commonly occurs in older patients with known underlying lung disease. Many are frail, but the effect of frailty on outcomes has not previous been explored. This study arms to evaluate the association between frailty and healthcare outcomes in patients with SSP.
Methods
Patients with SSP were identified from the national Secure Anonymised Information Linkage (SAIL) databank. Frailty status was assessed using the electronic frailty index (eFI). The primary outcome was time from diagnosis to all-cause mortality. Secondary outcomes included time from diagnosis to disease-specific mortality and admission to hospital. Data were analysed using a multi-level Cox proportional hazards regression model, adjusted for age, sex, Welsh Index of Multiple Deprivation, smoking status and co-morbidities.
Results
Our search identified 3535 individuals diagnosed with SSP between 1st January 2005 and 1st March 2023. By the end of the study 2102 (59.6%) participants had died with a median follow-up of 683 days (IQR 159–1650). There was an increasing risk of mortality for those with mild (aHR 1.24, 95% CI 1.10–1.39), moderate (aHR 1.46, 95% C 1.25–1.70) and severe (aHR 1.83, 95% CI 1.43–2.32) frailty compared to fit individuals. There was also an association between frailty and time to first all-cause hospitalisation, but not disease-specific hospitalisation.
Conclusions
Frailty status at diagnosis was an independent predictor of all-cause mortality in patients with SSP. This demonstrates the importance of assessing frailty status to enable clinicians to provide optimised care and make informed decisions about management of patients with SSP.
Secondary spontaneous pneumothorax (SSP) most commonly occurs in older patients with known underlying lung disease. Many are frail, but the effect of frailty on outcomes has not previous been explored. This study arms to evaluate the association between frailty and healthcare outcomes in patients with SSP.
Methods
Patients with SSP were identified from the national Secure Anonymised Information Linkage (SAIL) databank. Frailty status was assessed using the electronic frailty index (eFI). The primary outcome was time from diagnosis to all-cause mortality. Secondary outcomes included time from diagnosis to disease-specific mortality and admission to hospital. Data were analysed using a multi-level Cox proportional hazards regression model, adjusted for age, sex, Welsh Index of Multiple Deprivation, smoking status and co-morbidities.
Results
Our search identified 3535 individuals diagnosed with SSP between 1st January 2005 and 1st March 2023. By the end of the study 2102 (59.6%) participants had died with a median follow-up of 683 days (IQR 159–1650). There was an increasing risk of mortality for those with mild (aHR 1.24, 95% CI 1.10–1.39), moderate (aHR 1.46, 95% C 1.25–1.70) and severe (aHR 1.83, 95% CI 1.43–2.32) frailty compared to fit individuals. There was also an association between frailty and time to first all-cause hospitalisation, but not disease-specific hospitalisation.
Conclusions
Frailty status at diagnosis was an independent predictor of all-cause mortality in patients with SSP. This demonstrates the importance of assessing frailty status to enable clinicians to provide optimised care and make informed decisions about management of patients with SSP.
| Original language | English |
|---|---|
| Number of pages | 17 |
| Journal | ERJ Open Research |
| Early online date | 25 Jul 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 25 Jul 2025 |