This large-scale review of the Dutch Lung Cancer Audit for Surgery Database summarizes the variability in the current practice in surgical care for primary spontaneous pneumothorax. A total of 1,851 patients were reviewed. The most performed surgical procedure across the country was a bullectomy with pleurodesis (83 percent). There was significant variation in length of stay and complication rates across hospitals. This study showcases the power of using large scale national databases to outline current practices nationwide thus identifying target areas and opportunities for improvement nationally.