A prospective national cohort study of patients with secondary spontaneous pneumothorax assessing the impact of frailty at diagnosis on mortality and admission to hospital.

Barton, Eleanor C., Short, Roxanna, Verduri, Alessia, Hewitt, Jonathan ORCID: https://orcid.org/0000-0002-7924-1792, Walker, Steven, Carter, Ben and Maskell, Nick A. 2025. A prospective national cohort study of patients with secondary spontaneous pneumothorax assessing the impact of frailty at diagnosis on mortality and admission to hospital. ERJ Open Research 11 (6) , 00316-2025. 10.1183/23120541.00316-2025

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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 been explored previously. This study aims 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 databank. Frailty status was assessed using the electronic frailty index. 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 multilevel Cox proportional hazards regression model, adjusted for age, sex, Welsh Index of Multiple Deprivation, smoking status and comorbidities. Results Our search identified 3535 individuals diagnosed with SSP between 1 January 2005 and 1 March 2023. By the end of the study, 2102 (59.6%) participants had died with a median follow-up of 683 days (interquartile range 159–1650 days). There was an increasing risk of mortality for those with mild (adjusted hazard ratio (aHR) 1.24, 95% CI 1.10–1.39), moderate (aHR 1.46, 95% CI 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.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: Title: cc by, Type: cc by
Publisher:	European Respiratory Society
Date of First Compliant Deposit:	18 December 2025
Date of Acceptance:	21 April 2025
Last Modified:	18 Dec 2025 11:00
URI:	https://orca.cardiff.ac.uk/id/eprint/183350

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