Is daily chest X-ray necessary after lung resection? Evidence-based decision making

Abstract

The 'gold standard' practice following insertion of a chest tube after lobectomy is daily chest radiography (CXR), but this is not always followed. We compared the outcomes associated with the use of these two methods in our practice. Data from 148 patients who underwent uncomplicated lobectomies with insertion of one chest drain were analysed. In the routine CXR group (R-CXR) (50 patients), an immediate postoperative CXR, daily routine radiography during the drainage period, and one after surgical drain removal were performed. In the symptomatic CXR group (S-CXR) (98 patients), a CXR was performed only for symptomatic patients (fever, hypoxia, subcutaneous emphysema, air leak) and/or a single radiograph was taken after surgical drain removal. The following postoperative data were compared: fever, CXR abnormalities (pneumothorax, fluid, atelectasis, subcutaneous emphysema, haematoma), number of radiographs, drainage time, and new drain insertion. The mean chest tube duration was 3.7 and 3.8 days in the R-CXR and S-CXR groups, respectively. Abnormal CXRs after surgical drain removal were reported in 50% (25/50) and 46.9% (46/96) (p = 0.724) of patients in the R-CXR and S-CXR groups, respectively, but new drain insertion was only necessary in 3/25 (12%) and 7/46 (15.2%) of these cases. The mean number of CXRs for each patient was 5.0 and 2.3 (p = 0.0001) in the R-CXR and S-CXR groups, respectively. If CXRs are limited to symptomatic patients then the number of radiographs can be reduced by around 50%. There were no more postoperative complications or abnormal final CXR findings if the CXR was only ordered for symptomatic patients instead of as 'daily routine' during the postoperative period. Only 12-15% of the CXR abnormalities required surgical intervention.