The Interest of Performing "On-Demand Chest X-rays" after Lung Resection by Minimally Invasive Surgery

Thorac Cardiovasc Surg. 2017 Oct;65(7):572-580. doi: 10.1055/s-0037-1599793. Epub 2017 Apr 11.

Abstract

Background There is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice. Methods This prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization. Results The length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7). Conclusion On-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity-mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Chest Tubes
  • Drainage / instrumentation
  • France
  • Health Services Needs and Demand*
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pneumonectomy / adverse effects
  • Pneumonectomy / methods*
  • Pneumonectomy / mortality
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Predictive Value of Tests
  • Prospective Studies
  • Radiography, Thoracic*
  • Robotic Surgical Procedures* / adverse effects
  • Robotic Surgical Procedures* / mortality
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Thoracic Surgery, Video-Assisted* / mortality
  • Time Factors
  • Treatment Outcome