title: Are daily routine chest radiographs necessary after pulmonary surgery in adult patients?
abstract: A best evidence topic was constructed according to a structured protocol. The question addressed was whether daily routine (DR) chest radiographs (CXRs) are necessary after pulmonary surgery in adult patients. Of the 66 papers found using a report search, seven presented the best evidence to answer the clinical question. Four of these seven studies specifically addressed post-cardiothoracic adult patients. Three of these seven studies addressed intensive care unit (ICU) patients and included post-cardiothoracic adult patients in well-designed studies. Six of these seven studies compared the DR CXRs strategy to the clinically indicated, on-demand (OD) CXRs strategy. Another study analysed the clinical impact of ceasing to perform the DR, postoperative, post-chest tubes removal CXRs. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the seven studies are unanimously in favour of forgoing DR CXRs after lung resection and advocate OD CXRs. One study suggested that hypoxic patients could benefit from a DR CXRs strategy, while other studies failed to identify any subgroup for whom performing DR CXRs was beneficial. Indeed, DR CXRs, commonly taken after thoracic surgery, have poor diagnostic and therapeutic value. Eliminating them for adult patients having undergone thoracic surgery significantly decreases the number of CXRs per patient without increasing mortality rates, length of hospital stays (LOSs), readmission rates and adverse events. Hence, current evidence shows that DR CXRs could be forgone after lung resection because OD CXRs, recommended by clinical monitoring, have a better impact on management and have not been proved to negatively affect patient outcomes. Moreover, an OD CXRs strategy lowers the cost of care. Nevertheless, an OD CXRs strategy requires close clinical monitoring by experienced surgeons and dedicated intensivists. However, given the published studies' low level of evidence, prospective and randomized trials, specifically after thoracic surgery, are necessary in order to confirm these results.
authors: Department of Thoracic Surgery, University Hospital, Strasbourg, France.
authors: Jeremie
authors: J
authors: Reeb
authors: Pierre-Emmanuel
authors: PE
authors: Falcoz
authors: Anne
authors: A
authors: Olland
authors: Gilbert
authors: G
authors: Massard
mesh_terms: D000328:Adult; D000368:Aged; D019985:Benchmarking; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011237:Predictive Value of Tests; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013902:Radiography, Thoracic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: Chest radiography; Cost of care; Outcomes; Thoracic surgery
references: Interact Cardiovasc Thorac Surg. 2003 Dec;2(4):405-9
references: 17670084
references: J Thorac Cardiovasc Surg. 1998 Jan;115(1):45-50; discussion 50-2
references: 9451044
references: Radiology. 2010 May;255(2):386-95
references: 20413752
references: J Thorac Cardiovasc Surg. 2007 Jul;134(1):139-44
references: 17599499
references: Surgeon. 2009 Apr;7(2):79-81
references: 19408798
references: Ann Thorac Surg. 2011 Aug;92(2):440-3
references: 21704293
references: Intensive Care Med. 2007 Apr;33(4):639-44
references: 17333118
references: Lancet. 2009 Nov 14;374(9702):1687-93
references: 19896184