The routine use of chest x-ray (CXR) to evaluate the pleural space after chest tube removal is a common practice driven primarily by surgeon preference and institutional protocol. The results of these postpull CXRs frequently lead to additional interventions that serve only to increase health care costs and resource utilization. We investigated the utility of these postpull CXRs in thoracic surgery patients and assessed their effectiveness in predicting the need for tube replacement.
Single-institution retrospective study comprising thoracic surgery patients requiring postoperative chest tube drainage over a 3-y period. Demographics and surgical characteristics, including surgical approach, procedure, and procedure type, were recorded. Outcomes included postpull CXR findings, interventions resulting from radiographic abnormalities, and the additional health resource utilization incurred by obtaining these studies on asymptomatic patients.
The study included 433 patients. Postpull CXRs were performed in 87.1% of patients, with 33.2% demonstrating an abnormality compared with the prior study. Among these, 65.7% resulted only in repeat imaging and 25.7% resulted in discharge delay. Overall, a total of 13 patients (3%) required chest tube replacement, three during the index hospitalization and the other 10 requiring readmission. Among those requiring chest tube replacement, 75% had normal postpull imaging, and all were symptomatic.
Recurrent pneumothorax after chest tube removal requiring immediate tube reinsertion is relatively rare and does not occur in the absence of symptoms. Our study suggests that routine postpull CXRs have limited clinical utility and can be safely omitted in asymptomatic patients with appropriate clinical observation.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Surgical Research
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Is a chest radiograph after thoracostomy tube removal necessary? A cost-effective analysis.Injury. 2020; 51: 2493-2499
- What is the yield of routine chest radiography following tube thoracostomy for trauma?.Injury. 2015; 41: 45-48
- Is routine roentgenography needed after closed tube thoracostomy removal?.J Trauma. 2000; 48: 684-688
- The efficacy of X-rays after chest tube removal.Am J Surg. 2000; 179: 13-16
- Is routine chest radiograph necessary after chest tube removal?.J Pediatr Surg. 2014; 49: 1493-1495
- Do X-rays after chest tube removal change patient management?.J Pediatr Surg. 2017; 52: 813-815
- Is a chest radiograph required after removal of chest tubes in children?.J Pediatr Health Care. 2017; 31: 588-593
- Are chest radiographs routinely necessary following thoracostomy tube removal?.Pediatr Radiol. 2002; 32: 138-142
- The routine use of chest radiographs after chest tube removal in children who have had cardiac surgery.J Pediatr Health Care. 2013; 27: 189-194
- The use of routine chest X-ray films after chest tube removal in postoperative cardiac patients.Ann Thorac Surg. 2002; 74: 2161-2164
- Are chest radiographs routinely indicated after chest tube removal following cardiac surgery?.Am J Roentgenol. 2011; 197: 122-124
- The clinical value of routine chest radiographs in the first 24 hours after cardiac surgery.Anesth Analg. 2011; 112: 139-142
- Is routine chest X-ray following mediastinal drain removal after cardiac surgery useful?.Eur J Cardiothorac Surg. 2008; 34: 542-544
- Are chest radiographs routinely indicated after chest tube removal following non-surgical placement?.Cureus. 2020; 12: e7339
- Routine chest X-rays after thoracic surgery are unnecessary.J Surg Res. 2020; 250: 188-192
- The necessity of routine post thoracostomy tube chest radiographs in post-operative thoracic surgery patients.Surgeon. 2009; 7: 79-81
- Reducing unnecessary chest X-ray films after thoracic surgery: a quality improvement initiative.Ann Thorac Surg. 2021; 111: 1012-1018
- Impact and experiences of delayed discharge: a mixed-studies systematic review.Health Expect. 2018; 21: 41-56
- Routine chest X-rays after the removal of chest tubes are not necessary following esophagectomy.J Thorac Dis. 2019; 11: S799-S804
Published online: March 25, 2022
Accepted: February 21, 2022
Received in revised form: February 9, 2022
Received: July 20, 2021
© 2022 Elsevier Inc. All rights reserved.