Is Routine Postoperative Chest Radiography Needed After Percutaneous Nephrolithotomy?

Bjurlin, Marc A.; O'Grady, Thomas; Kim, Ronald; Jordan, Michael D.; Goble, Sandra; Hollowell, Courtney M.P.

doi:10.1016/j.urology.2011.08.053

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…Further, routine chest X-ray was found to not change patient management when used as a pre and post op screening, at hospital admission, in medical check-ups, or in staging of cervical and breast cancer. Repeat chest X-ray in trauma and ICU patients was found to be low-value and clinical symptoms should be used as an indicator to do an X-ray [ 78 – 93 , 113 , 118 – 120 ]. In CT, low-value examinations were found in emergency department patients, pleural effusion, and in staging of low-grade breast cancer as the diagnostic yield is low [ 114 – 116 ].…”

Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Resultsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…Therefore, CXR was performed to identify thoracic complications in the postoperative period in patients with supracostal access, regardless of the presence or absence of clinical symptoms (e.g., difficulty in ventilation and shortness of breath) and physical examination findings. 8,13 Anatomically, the parietal pleura crosses the middle of the 12 th rib posteriorly and the 11 th rib at the posterior axillary line. 18 A safe zone is present on the lateral side of the intersection between the 11 th intercostal space and the middle scapular line, which minimizes the risk of pleural injury.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Some clinical symptoms (difficulty with ventilation, shortness of breath, and fever), physical examination findings (decreased breath sounds), and radiographic findings of pleural injury on chest radiographs have been observed in patients with thoracic complications in the acute postoperative period of PCNL. 8 In the literature, tables, parameters, or nomograms are used to predict the possibility of stone clearance. 9 However, there are no known parameters that can estimate the risk of complications.…”

Section: Introductionmentioning

confidence: 99%

Costovertebral angle as a novel tool for predicting the thoracic complication risk following percutaneous nephrolithotomy requiring supracostal access

Güzel

Oksay

Öztürk

et al. 2021

CUAJ

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Introduction: The objective of this study was to determine whether the costovertebral angle (CVA) and other factors can predict the risk of thoracic complications following percutaneous nephrolithotomy (PCNL). Methods: The data of patients who underwent prone PCNL with supracostal access at Suleyman Demirel University Hospital between January 2015 and December 2019 were retrospectively reviewed. Patients’ demographics information (age, sex, body mass index [BMI], stone size, and stone location), operative data (supracostal access site, renal puncture site, and laterality), and postoperative thoracic complications (pleural injury) were evaluated. The CVA was measured on preoperative posteroanterior chest X-ray images. The mean CVA of patients with and without thoracic complications was evaluated. Results: A total of 89 patients (mean age 46.12±15.66 years; 59 men and 30 women) with supracostal access were included in the study. Thoracic complications occurred in 17 (19.1%) patients. Nine (52.9%) hemothorax cases, five (29.4%) pneumothorax cases, and three (17.7%) urinothorax cases were detected. There was a statistically significant difference in the complication rate compared to the percutaneous access site (10th–11th supracostal vs. 11th–12th supracostal) (p=0.004). The mean CVA was significantly lower in patients with complications (45.47±3.59) than in those without complications (53.26±5.98) (p=0.000). No association was found (p>0.05) with age, sex, BMI, laterality, stone surface area, and access site among patients with and without thoracic complications. Conclusions: Preoperative CVA can be an effective tool in predicting the risk of postoperative thoracic complications.

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“…12 patients (8%) had urinary leakage from the nephrostomy site which resolved spontaneously in 9 patients while 3 patients required double J insertion due to persistent leakage. The rate of injury to the pleura during PNL ranges from 0.3% to 1% (19) (20) (21). Supracostal percutaneous renal access is associated with a higher risk of thoracic complications (5.3%) as compared to subcostal access (1.4%) (22).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Complications of PNL in Solitary Kidney: A Prospective Study.

Mahmoud

Saleem

Saber-Khalaf

et al. 2020

Sohag Medical Journal

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Is Routine Postoperative Chest Radiography Needed After Percutaneous Nephrolithotomy?

Cited by 13 publications

References 17 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Costovertebral angle as a novel tool for predicting the thoracic complication risk following percutaneous nephrolithotomy requiring supracostal access

Predictive Factors of Complications of PNL in Solitary Kidney: A Prospective Study.

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