Rare But Risky: Clinical Impacts of Pneumothorax After Thyroidectomy and Parathyroidectomy.

Abstract

Postoperative pneumothorax (PPTX) after thyroidectomy (TD) or parathyroidectomy (PT) is rare and primarily described in case reports with limited data on its prognostic significance in large populations. We aim to assess the incidence of PPTX and its association with clinical outcomes following TD or PT. We queried the TriNetX United States Research Network, identifying patients ≥ 18 years of age who underwent open TD or PT between January 2000 and December 2025. Patients were separated by development of PTX within 7 days postoperatively. Outcomes were assessed at 3 and 6 months using odds ratios (ORs) and at 1 year using hazard ratios (HRs), with 95% confidence intervals (CIs). The primary outcome was all-cause mortality; secondary outcomes included risks for pneumonia, dysphagia, vocal cord paralysis, and need for mechanical ventilation as well as healthcare utilization rates. Among 228,340 patients undergoing surgery, 237 (0.10%) developed PPTX. At 1 year, PPTX was associated with increased risk of all-cause mortality (HR 16.44, 95% CI 11.16-24.23), pneumonia (HR 6.14, 95% CI 3.48-10.83), dysphagia (HR 4.86, 95% CI 3.23-7.33), vocal cord paralysis (HR 5.19, 95% CI 3.31-8.15), and need for mechanical ventilation (HR 18.13, 95% CI 10.89-30.17). PPTX was also associated with higher rates of hospital readmission (HR 15.12, 95% CI 11.97-19.10) and emergency room visits (HR 2.09, 95% CI 1.33-2.28) (all p < 0.01). All outcomes were also significant at 3 and 6 months after surgery. PPTX after TD or PT is exceedingly uncommon but associated with significantly worse mortality and morbidity.