Routine Chest Roentgenogram After Chest Tube Removal Is Not Indicated for Minimally Invasive Lung Resection

Abstract

Background: Chest roentgenograms after chest tube removal are common practice in postoperative thoracic surgery patients. Whether these roentgenograms change clinical management is debatable. We investigated prevalence and management of post-pull pneumothoraces after lung resection.

Methods: Patients undergoing minimally invasive wedge resections, segmentectomies, and lobectomies between March 2018 and September 2018 were retrospectively reviewed. Baseline factors, operative technique, chest tube management, and outcomes after post-pull chest roentgenograms, and factors associated with post-pull pneumothoraces were analyzed.

Results: The study analyzed 200 consecutive patients comprising 117 wedge resections (59%), 24 segmentectomies (12%), and 59 lobectomies (30%). Wedge resections compared with segmentectomy or lobectomy had lower rates of chest tube use, drain duration, air leaks, and need for a clamp trial, with Blake drains most often removed last compared with segmentectomy or lobectomy (all P < .001). Post-pull pneumothoraces, which were largely small/tiny/trace (96%), occurred in 110 patients (55%). Five patients experienced symptoms, and no patients required intervention. Resection type was associated with the pneumothorax rate, need for additional imaging, and discharge timing (all P < .05). Those with pneumothoraces compared with those without differed in type of resection and chest drain, presence of air leak within 24 hours of removal, need for clamp trial, order of tube removal, and hospital length of stay (all P < .05). Multivariable regression showed only clamp trial was associated with post-pull pneumothorax development (odds ratio, 2.48; 95% CI, 1.13-5.45; P = .024).

Conclusions: Although routine use of post-pull chest roentgenograms identified a high prevalence of pneumothorax, no intervention was required. Our study demonstrates post-pull imaging may not be indicated in asymptomatic patients without prior air leak or clamp trial.