Background: This study aims to evaluate preoperative, perioperative, and postoperative parameters in patients with primary spontaneous pneumothorax (PSP) to minimize recurrence and improve predictability. Methods: This single-center retrospective cohort study included 207 patients who underwent surgery for PSP between 2016 and 2020. Recurrence data were obtained from the national electronic health record system and the institutional hospital information system. Pneumothorax size was calculated preoperatively on posteroanterior chest radiographs using the Collins method. Results: The mean age of the patients was 24.54+/-6.98 years and 87% of the patients were male. The overall recurrence rate was 9.7%. A higher Collins percentage (p<0.001), age <=20 years (p=0.015), and continued smoking postoperatively (p=0.036) were found to be significantly associated with increased recurrence. Conclusion: The findings suggest that a high Collins percentage on posteroanterior chest radiography, young age at the time of surgery, and continued smoking postoperatively are significant risk factors for recurrence.