title: Routinely obtained chest X-rays after elective video-assisted thoracoscopic surgery can be omitted in most patients; a retrospective, observational study.
abstract: OBJECTIVE
  To investigate whether the use of routinely obtained chest X-rays is necessary after elective VATS.
  
  
  METHODS
  We retrospectively reviewed 1097 chest X-rays obtained routinely after elective VATS, performed in patients aged over 15 years during an 18-month period. VATS procedures were divided into three groups according to the degree of pulmonary resection. The chest X-rays (obtained anterior-posterior in one plane with the patient in the supine position) were categorized as abnormal if showing pneumothorax >5 cm, possible intra-thoracic bleeding and/or a displaced chest tube. Medical charts were reviewed for all patients with abnormal chest X-rays to see if an intervention was made based on the X-ray. In case of an intervention, detailed clinical data were collected.
  
  
  RESULTS
  44 of 1097 chest X-rays (4.0 %) were abnormal and 10 of these X-rays (0.9 %) led to a clinical intervention. Proportions of abnormal chest X-rays were unequally distributed between groups (p < 0.001), whereas the number of interventions was not (p = 0.43). Of the ten chests X-rays that led to an intervention, three showed possible intra-thoracic bleeding, six showed pneumothorax >5 cm and one showed a kinked chest tube. All the patients with possible intra-thoracic bleeding were re-explored in the operating theatre the same day.
  
  
  CONCLUSIONS
  Only 10 of 1097 chest X-rays (0.9 %) obtained routinely after elective VATS procedures led to a clinical intervention, supporting the abandon of routine chest X rays in favour of a more individualised approach, based on clinical observations.
authors.affiliation: Department of Cardiothoracic Anaesthesia and Section for Surgical Pathophysiology, Rigshospitalet Dept. 7621, Copenhagen University Hospital, Copenhagen, Denmark, lars.stryhn.bjerregaard@regionh.dk.
authors.forename: Lars S
authors.initials: LS
authors.lastname: Bjerregaard
authors.forename: Katrine
authors.initials: K
authors.lastname: Jensen
authors.forename: René Horsleben
authors.initials: RH
authors.lastname: Petersen
authors.forename: Henrik Jessen
authors.initials: HJ
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D017558:Elective Surgical Procedures / Q000379:methods; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*