Can my patient dive after a first episode of primary spontaneous pneumothorax? A systematic review of the literature

Introduction: Patients with prior primary spontaneous pneumothorax (PSP) frequently seek clearance to dive. Despite wide consensus in precluding compressed-air diving in this population, there is a paucity of data to support this decision. We reviewed the literature reporting the risk of PSP recurrence. Methods: A literature search was performed in PubMed and Web of Science using predefined terms. Studies published in English reporting the recurrence rate after a first PSP were included. Results: Forty studies (n=3,904) were included. Risk of PSP recurrence ranged 0-67% (22 ± 15.5%; mean ± SD). Mean follow- up was 36 months, and 63 ± 39% of recurrences occurred during the first year of follow-up. Elevated height/weight ratio and emphysema-like changes (ELCs) are associated with PSP recurrence. ELCs are present in 59%-89% (vs. 0-15%) of patients with recurrence and can be detected effectively with high-resolution CT scan (sensitivity of 84-88%). Surgical pleurodesis reduces the risk of recurrence substantially (4.0±4% vs. 22±15.5%). Conclusions: Risk of PSP recurrence seems to decline over time and is associated to certain radiological and clinical risk factors. This could be incremented by the stresses of compressed-air diving. A basis for informed patient-physician discussions regarding future diving is provided in this review.