Abstract
Introduction
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: March 25, 2022
Accepted:
February 21,
2022
Received in revised form:
February 9,
2022
Received:
July 20,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
