The value of routine chest radiographs after minimally invasive cardiac surgery: an observational cohort study.
BACKGROUND
Chest radiographs (CXRs) are obtained frequently in postoperative cardiac surgery patients. The diagnostic and therapeutic efficacy of routine CXRs is known to be low and the discussion regarding the safety of abandoning these CXRs after cardiac surgery is still ongoing. We investigated the value of routine CXRs directly after minimally invasive cardiac surgery.


METHODS
We prospectively included all patients who underwent minimally invasive cardiac surgery by port access, ministernotomy or bilateral video-assisted thoracoscopy (VATS) in the year 2012. A direct postoperative CXR was performed on all patients at ICU arrival. All CXR findings were noted, including whether they led to an intervention or not. The results were compared to the postoperative CXR results in patients who underwent conventional cardiac surgery by full median sternotomy over the same period.


RESULTS
A total of 249 consecutive patients were included. Most of these patients underwent valve surgery, rhythm surgery or a combination of both. The diagnostic efficacy for minor findings was highest in the port access and bilateral VATS groups (56% and 63% versus 28% and 45%) (p < 0.005). The diagnostic efficacy for major findings was also higher in these groups (8.9% and 11% versus 4.3% and 3.8%) (p = 0.010). The need for an intervention was most common after minimally invasive surgery by port access, although this difference was not statistically significant (p = 0.056).


CONCLUSIONS
The diagnostic efficacy of routine CXRs performed after minimally invasive cardiac surgery by port access or bilateral VATS is higher than the efficacy of CXRs performed after conventional cardiac surgery. A routine CXR after these procedures should still be considered.
Department of Anesthesiology & Intensive Care, Isala Klinieken, Dokter van Heesweg 2, 8025, AB, Zwolle, The Netherlands. martijntolsma@gmail.com.
Martijn
M
Tolsma
Department of Cardiothoracic Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands. mbentala@amphia.nl.
Mohamed
M
Bentala
Department of Anesthesiology & Intensive Care, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands. prosseel@amphia.nl.
Peter M J
PM
Rosseel
Department of Anesthesiology & Intensive Care, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands. bgerritse@amphia.nl.
Bastiaan M
BM
Gerritse
Department of Radiology, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands. hdijkstra@amphia.nl.
Homme A J
HA
Dijkstra
Amphia Hospital, Amphia Academy, Molengracht 21, 4818, CK, Breda, The Netherlands. pgh.mulder@hccnet.nl.
Paul G H
PG
Mulder
Department of Anesthesiology & Intensive Care, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands. bvandermeer@amphia.nl.|TiasNimbas Business School, Tilburg University, Warandelaan 2, 5037, AB, Tilburg, The Netherlands. bvandermeer@amphia.nl.
Nardo J M
NJ
van der Meer
D000368:Aged; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D056346:Sternotomy; D020775:Thoracic Surgery, Video-Assisted