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

Abstract

(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.

Are routine, daily chest radiographs (CXR) necessary following (VATS and RATS) lobectomies?

“…Our findings highlight the importance of emphasizing a patient's symptoms and physical exam findings as the main determinant of altering clinical management. Our findings including VATS and RATS patients echoes prior literature in a heterogenous group of thoracic surgeries where clinical evaluation rather than serial CXR led to changes in management [ 2 , 15 , 21 ]. As clinical guidelines regarding obtaining post-operative CXR after VATS/RATS is non-existent, practice patterns vary widely not only on a national level, but even within our own institutional practice [ 21 , 22 ].…”

“…Our findings including VATS and RATS patients echoes prior literature in a heterogenous group of thoracic surgeries where clinical evaluation rather than serial CXR led to changes in management [ 2 , 15 , 21 ]. As clinical guidelines regarding obtaining post-operative CXR after VATS/RATS is non-existent, practice patterns vary widely not only on a national level, but even within our own institutional practice [ 21 , 22 ]. At our institution, the mean number of total CXRs was higher in those that required an additional procedure at approximately 6 CXRs compared to 4 CXRs in those who did not need a procedure.…”

Chest Tube Management: Past, Present, and Future Directions for Developing Evidence-Based Best Practices

“…Instead, CXR may be safely ordered based on clinical signs and symptoms—decreasing radiation exposure to patients and staff and reducing costs of care without adversely affecting adverse events, LOS, readmissions, or mortality. 57,58…”

“…Instead, CXR may be safely ordered based on clinical signs and symptoms-decreasing radiation exposure to patients and staff and reducing costs of care without adversely affecting adverse events, LOS, readmissions, or mortality. 57,58 Similarly, recent evidence indicates that routine CXR after cardiac and thoracic surgery and chest tube removal is not indicated. Instead, clinical symptoms such as respiratory or hemodynamic changes appear to be a reliable predictor of pneumothorax requiring chest tube reinsertion.…”

Lung Ultrasound Reduces Chest X-rays in Postoperative Care after Thoracic Surgery: Is There a Role for Artificial Intelligence?—Systematic Review

“…The optimal management of chest tubes and their removal after non-cardiac thoracic surgery and the role of imaging modalities in the detection of PTX, PE, and other conditions remain unclear [ 28 , 29 , 30 , 31 , 32 ]. Standardized protocols among thoracic surgery departments are missing, and the strategy varies from daily routine CXR to the omission of any imaging modality, especially thanks to the introduction of modern digital drainage systems [ 33 , 34 ]. Several trials studied the role of CXR in postoperative care after non-cardiac thoracic surgery with the goal of decreasing the CXR numbers [ 35 , 36 ].…”