title: Routine postoperative chest X-ray is unnecessary following the Nuss procedure for pectus excavatum.
abstract: OBJECTIVE
  Pneumothorax is the most common complication after the Nuss procedure for pectus excavatum. The majority of pneumothoraces are small, and the patients have no symptoms. The aim of this study was to evaluate the necessity for routine chest X-ray immediately after surgery.
  
  
  METHODS
  Group I consists of 644 patients who were operated on with a Nuss procedure for pectus excavatum between 2001 and 2009 (85% male, median age 16 [range 7-48 years]) at Aarhus University Hospital. The standard procedure included chest X-ray immediately after surgery and before discharge. Group II consists of 294 patients (88% male, median age 16 [range 11-54 years]) who had a Nuss procedure in the period January 2011 to October 2012, where the standard procedure only included chest X-ray before discharge.
  
  
  RESULTS
  In Group I, pneumothorax was found on the chest X-ray obtained immediately after surgery in 333 (52%) patients. Fifteen (4.5%) were treated with chest-tube drainage. Six of these patients had no symptoms, but a 2- to 3-cm pneumothorax, 2 had progression of the pneumothorax and 7 had respiratory symptoms. The median size of those drained was 3 (range 2-6 cm). At the normal 6-week control, no pneumothorax remained. Group II: Among the 294 patients, 1 (0.3%) had a chest tube.
  
  
  CONCLUSIONS
  Only patients with respiratory symptoms after the Nuss procedure need a chest X-ray. A routine chest X-ray can be limited to the time of discharge where the position of the bar(s) is also checked.
authors: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors: Mette Reinholdt
authors: MR
authors: Knudsen
authors: Camilla
authors: C
authors: Nyboe
authors: Vibeke E
authors: VE
authors: Hjortdal
authors: Hans K
authors: HK
authors: Pilegaard
mesh_terms: D000293:Adolescent; D000328:Adult; D015505:Chest Tubes; D002648:Child; D003718:Denmark; D004322:Drainage / Q000295:instrumentation; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010351:Patient Discharge; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D011182:Postoperative Care; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Chest X-ray; Chest tube drainage; Complications; Pectus excavatum; Pneumothorax; The Nuss procedure