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Research Article|Articles in Press

Routine Chest Radiography After Thoracostomy Tube Removal and During Postoperative Follow-Up is Not Necessary After Lung Resection

Published:May 24, 2023DOI:https://doi.org/10.1016/j.jtcvs.2023.05.017
Routine Chest Radiography After Thoracostomy Tube Removal and During Postoperative Follow-Up is Not Necessary After Lung Resection
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      Abstract

      Objectives

      The need for routine chest radiography (CXR) following chest tube removal after elective pulmonary resection may be unnecessary in most patients. The purpose of this study was to determine the safety of eliminating routine CXR in these patients.

      Methods

      Patients who underwent elective pulmonary resection, excluding pneumonectomy, for benign or malignant indications between 2007-2013 were reviewed. Patients with in-hospital mortality or without routine follow-up were excluded. During this interval, our practice transitioned from ordering routine CXRs post-chest tube removal and at first postoperative clinic visit to obtaining imaging based on symptomatology. The primary outcome was changes in management from results of CXRs obtained routinely versus for symptoms. Characteristics and outcomes were compared using Student’s t-test and chi-squared analyses.

      Results

      A total of 322 patients met inclusion criteria. Ninety-three underwent a routine same-day post-pull CXR and 229 did not. Thirty-three (14.4%) in the non-routine CXR cohort had imaging for symptoms, of which eight cases (24.2%) resulted in management changes. Only 3.2% of routine post-pull CXR resulted in management changes versus 3.5% of unplanned CXRs with no adverse outcomes (p=0.905). At outpatient postoperative follow-up, 146 patients received a routine CXR; none resulted in a change in management. Of the 176 that did not have a planned CXR at follow-up, 12 patients (6.8%) underwent a CXR for symptoms. Two of these patients required readmission and chest tube re-insertion.

      Conclusion

      Reserving imaging for patients with symptoms at post-chest tube removal and follow-up after elective lung resections resulted in a higher percentage of meaningful changes in clinical management.

      Graphical abstract

      Figure thumbnail fx1
      Graphical Abstract

      Keywords

      Glossary of Abbreviations:

      CXR (chest radiograph), CT (chest tube (thoracostomy tube))
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      Article info

      Publication history

      Accepted: May 14, 2023
      Received in revised form: May 2, 2023
      Received: March 1, 2023

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosure Statement: This work was accepted for presentation at the AATS 103rd Annual Meeting in Los Angeles, CA. All authors report no conflicts of interest and have no relevant disclosures regarding the contents of this manuscript.

      Funding Statement: No funding support was used in conducting this study.

      Institutional Board Review Approval

      This study was approved by the University of Cincinnati Medical Center Institutional Review Board; IRB#: 2013-5266, Date of Approval: 8/29/13

      Central Message: Routine chest radiography following chest tube removal after lung resection rarely results management changes. A selective approach to obtaining chest imaging based on symptoms and/or signs is safe.

      Perspectives Statement: The utility of routine chest x-rays following lung resection has been debated; however, no guidelines exist. We demonstrated that routine chest x-rays following chest tube removal and at post-operative follow-up rarely leads to management changes. A selective approach of ordering chest x-rays only in those with concerning symptoms/signs is safe and has the potential to lead to significant cost savings.

      Identification

      DOI: https://doi.org/10.1016/j.jtcvs.2023.05.017

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery

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