Are Routine Chest Radiographs After Chest Tube Removal in Thoracic Surgery Patients Necessary?

Zukowski, Monica; Haas, Alec; Schaefer, Eric; Shen, Chan; Reed, Michael F.; Taylor, Matthew D.; Go, Pauline H.

doi:10.1016/j.jss.2022.02.046

Cited by 8 publications

(21 citation statements)

References 18 publications

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“…After the full-text screening, 18 studies were included in the systematic review. Eleven studies were conducted in the United States of America [1][2][3]7,[10][11][12][13][14][15][16] , four studies in the United Kingdom [17][18][19][20] , one in the Netherlands 5 , one in Germany 21 and one in Iran 6 (Table 1). No other studies were identified through manual screening of references of the included studies and relevant reviews.…”

Section: Resultsmentioning

confidence: 99%

“…A chest X-ray is usually performed 2-4 hours after the removal of the chest drain. 1 The incidence of pneumothorax on the chest X-ray after removal of the drain varies greatly from 4 to 48%. 1,2,15,17,21 Nonetheless, only up to 0.5% of patients need a subsequent intervention after the positive radiographic findings.…”

Section: Cardiac Surgery Adult Patientsmentioning

confidence: 99%

“…1 The incidence of pneumothorax on the chest X-ray after removal of the drain varies greatly from 4 to 48%. 1,2,15,17,21 Nonetheless, only up to 0.5% of patients need a subsequent intervention after the positive radiographic findings. 1,2,17 The incidence of pneumothorax in asymptomatic patients is approximately 32.8%, but none of the patients required re-intervention.…”

Section: Cardiac Surgery Adult Patientsmentioning

confidence: 99%

“…1,2,15,17,21 Nonetheless, only up to 0.5% of patients need a subsequent intervention after the positive radiographic findings. 1,2,17 The incidence of pneumothorax in asymptomatic patients is approximately 32.8%, but none of the patients required re-intervention. They only had clinical observation and repeated the chest X-rays.…”

Section: Cardiac Surgery Adult Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review

Thet

Han

Hlwar

et al. 2022

Preprint

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Background: Chest X-rays are routinely obtained after removal of chest drains in patients undergoing cardiac and thoracic surgical procedures. However, a lack of guidelines and evidence could question the practice. Routine chest X-rays increase exposure to ionising radiation, increase healthcare costs and lead to overutilisation of available resources. This review aims to explore the evidence in the literature regarding the routine use of chest X-rays following the removal of chest drains. Materials & Method: A systematic literature search was conducted in PubMed, Medline via Ovid, Cochrane central register of control trials (CENTRAL) and ClinicalTrials.gov without any limit on the publication year. The references of the included studies are manually screened to identify potentially eligible studies. Results: A total of 375 studies were retrieved through the search and 18 studies were included in the review. Incidence of pneumothorax remains less than 10% across adult cardiac, and paediatric cardiac and thoracic surgical populations. The incidence may be as high as 50% in adult thoracic surgical patients. However, the re-intervention rate remains less than 2% across the populations. Development of respiratory and cardiovascular symptoms can adequately guide for a chest X-ray following the drain removal. As an alternative, bedside ultrasound can be used to detect pneumothorax in the thorax after the removal of a chest drain without the need for ionising radiation. Conclusion: A routine chest X-ray following chest drain removal in adult and paediatric patients undergoing cardiac and thoracic surgery is not necessary. It can be omitted without compromising patient safety. Obtaining a chest X-ray should be clinically guided. Alternatively, bedside ultrasound can be used for the same purpose without the need for radiation exposure.

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Section: Resultsmentioning

confidence: 99%

Section: Cardiac Surgery Adult Patientsmentioning

confidence: 99%

Section: Cardiac Surgery Adult Patientsmentioning

confidence: 99%

Section: Cardiac Surgery Adult Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review

Thet

Han

Hlwar

et al. 2022

Preprint

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“…This is a complex part because there is the clinical and the medicolegal point of view. A recently published retrospective study on 433 patients analyzed the rate of re-intervention after post-drain removal X-rays and found that only 3% of the patients required additional interventions, while 33% had an abnormal X-ray [ 14 ]. In our review, evidence from three studies with 466 post-drain removal X-rays showed a change in patient care in 7.29% of the cases.…”

Section: Discussionmentioning

confidence: 99%

Are Routine Chest X-rays Necessary following Thoracic Surgery? A Systematic Literature Review and Meta-Analysis

Galata

Ortolano

Shafiei

et al. 2022

Cancers

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(1) Background: The number of chest X-rays that are performed in the perioperative window of thoracic surgery varies. Many clinics X-ray patients daily, while others only perform X-rays if there are clinical concerns. The purpose of this study was to assess the evidence of perioperative X-rays following thoracic surgery and estimate the clinical value with regard to changes in patient care. (2) Methods: A systematic literature research was conducted up until November 2021. Studies reporting X-ray outcomes in adult patients undergoing general thoracic surgery were included. (3) Results: In total, 11 studies (3841 patients/4784 X-rays) were included. The X-ray resulted in changes in patient care in 488 cases (10.74%). In patients undergoing mediastinoscopic lymphadenectomy or thoracoscopic sympathectomy, postoperative X-ray never led to changes in patient care. (4) Conclusions: There are no data to recommend an X-ray before surgery or to recommend daily X-rays. X-rays immediately after surgery seem to rarely have any consequences. It is probably reasonable to keep requesting X-rays after drain removal since they serve multiple purposes and alter patient care in 7.30% of the cases.

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The Society of Thoracic Surgeons Expert Consensus Document on the Management of Pleural Drains After Pulmonary Lobectomy

Kent,

Mitzman,

Diaz-Gutierrez

et al. 2024

The Annals of Thoracic Surgery

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Are Routine Chest Radiographs After Chest Tube Removal in Thoracic Surgery Patients Necessary?

Cited by 8 publications

References 18 publications

Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review

Efficacy of Chest X-Rays after Drain Removal in Adult and Paediatric Patients Undergoing Cardiac and Thoracic Surgery: A Systematic Review

Are Routine Chest X-rays Necessary following Thoracic Surgery? A Systematic Literature Review and Meta-Analysis

The Society of Thoracic Surgeons Expert Consensus Document on the Management of Pleural Drains After Pulmonary Lobectomy

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