Research Article|Articles in Press

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

      This paper is only available as a PDF. To read, Please Download here.



      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.


      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.


      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.


      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


      Glossary of Abbreviations:

      CXR (chest radiograph), CT (chest tube (thoracostomy tube))
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect