Comparison of postoperative cardiopulmonary examinations and chest radiographs to detect pulmonary complications after adult tracheotomy.
OBJECTIVE
To prospectively evaluate the effectiveness of clinical cardiopulmonary examination compared with that of chest radiography in detecting postoperative pulmonary complications after tracheotomy in adults.


METHODS
One hundred consecutive patients undergoing tracheotomy were evaluated. Pulmonary complications were recorded, and the effectiveness of the physical examination was compared with that of the chest x-ray in detecting these complications. Patient age, sex, diagnosis, urgency of the procedure, and anesthetic technique were evaluated to determine any relationship to postoperative complications.


RESULTS
Of the 100 patients, 87 patients underwent postoperative chest radiography, and all patients had postoperative cardiopulmonary examinations. One patient (1%) had a bilateral pneumothorax, which was detected clinically and confirmed by a chest radiograph. Five patients had postoperative pulmonary edema confirmed by clinical examination and radiography. Additional minor complications were noted, including minor bleeding and stomal infection, for an overall complication rate of 13%.


CONCLUSIONS
All postoperative pulmonary complications were detected by physical examination. Therefore routine postoperative chest radiographs in uncomplicated tracheotomies are not necessary if a thorough postoperative cardiopulmonary examination is performed. Cost analysis reveals a savings of approximately $19,000 with the proposed criteria for postoperative chest x-ray.
Park
S Y
SY
Department of Otolaryngology, Albert Einstein Collegeof Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Smith
R V
RV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics / Q000209:etiology; D008297:Male; D010808:Physical Examination / Q000191:economics; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology; D013902:Radiography, Thoracic / Q000191:economics; D015656:Respiratory Mechanics; D013530:Surgical Wound Infection / Q000175:diagnosis; D014140:Tracheotomy / Q000009:adverse effects*