The Journal of Thoracic and Cardiovascular Surgery
Thoracic: LungRoutine chest radiography after thoracostomy tube removal and during postoperative follow-up is not necessary after lung resection
Graphical abstract
Section snippets
Study Design
A retrospective review of a prospectively collected database was performed on patients who underwent elective anatomic or nonanatomic lung resection from January 2007 to April 2013. During this time, our institution's practice was transitioning from ordering routine CXR upon CT removal (typically within four hours) and at the first outpatient postoperative follow-up (typically, 2 weeks postoperatively) to ordering CXR as indicated for symptoms and clinical signs of concern (new/increasing
Primary Outcome
A total of 322 patients met inclusion criteria (Figure 1). Of these, 93 patients received a routine post-pull CXR and 229 did not (Table 1). Post-pull CXR ordering practice by year ranged from 23% to 35%, and there was no clear inflection point due to varying surgeon practice during this time (Figure 2, A). Baseline patient characteristics did not differ between groups except significantly more Black/African American patients received routine CXR (22.6% vs 11.4%, P = .028). There was also no
Discussion
The necessity of ordering CXR after CT removal following pulmonary resection has been questioned for a long time.3,9,11 In 2008, we started the transition from ordering routine CXR the day of CT removal and at the first outpatient clinic visit to only ordering imaging on an as-needed basis. Our current routine is to order an immediate postoperative CXR and one 4 hours after the CT is placed on water seal and no further imaging unless a patient develops signs or symptoms that may indicate a
Conclusions
After elective lung resection, routine CXR obtained immediately after CT removal and at the first postoperative follow-up rarely, if ever, results in meaningful changes in management. This practice of routine CXR in asymptomatic patients is not only ineffective but also associated with significance cost and potential harm from unwarranted interventions. Using a selective approach to obtaining CXR based on concerning symptoms or signs is safe and has the potential to results in significant
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Cited by (0)
This study was approved by the University of Cincinnati Medical Center Institutional Review Board; IRB#: 2013 to 5266, date of approval: August 29, 2013.