The necessity of routine post-thoracostomy tube chest radiographs in post-operative thoracic surgery patients

Abstract

Background: Chest radiographs are routinely performed post-operatively in thoracic surgery patients, in particular after the removal of thoracostomy tubes. From observation of our practice, we hypothesised that chest radiographs did not need to be performed routinely post-operatively and after removal of thoracostomy tubes.

Aim: To determine whether routine chest radiographs post-operatively and post-thoracostomy tube removal directly influenced patient management.

Materials and methods: A five month prospective study was carried out to analyse our current practice at the Thoracic Surgery Unit, Bristol Royal Infirmary, Bristol, U.K. Demographic and clinico-pathological data were collected during admission.

Results: In the cohort of 74 patients, 66 (89%) patients had post-operative chest radiographs. Only three (5%) patients who had a chest radiograph had change in their management. Twenty-five (34%) patients had a chest radiograph post-thoracostomy tube removal. Only one (4%) patient in this group who had a chest radiograph after thoracostomy tube removal had a change of management. Interestingly, the decision to change patient management was not made on the basis of the chest radiographs alone; the clinical situation was the main determinant. Patients that did not have a chest radiograph postoperatively (eight patients, 11%) and post-thoracostomy tube removal (49 patients, 66%) did not suffer any adverse sequelae.

Conclusion: We feel our data support the hypothesis that it is not necessary to perform routine chest radiographs in thoracic surgery patients post-operatively and after post-operative thoracostomy tube removal. It would be better to monitor these patients clinically and only request chest radiographs on the basis of deterioration in recorded observations or clinical findings.