The role of chest radiography following pectus bar removal.
OBJECTIVE
Surgical correction of pectus excavatum (PE) via a minimally invasive approach involves placement of a steel bar, which is subsequently removed. The purpose of our study was to evaluate the incidence of pneumothorax and the role for chest radiography (CXR) in patients undergoing pectus bar removal.


METHODS
A retrospective review of 84 patients who underwent pectus bar removal from 2006 to 2014 was performed. Results of postoperative CXR, repeat imaging, need for chest thoracostomy tube placement, and complications were analyzed.


RESULTS
Mean Haller index prior to correction was 4.3 ± 0.9. The mean time between PE repair and bar removal was 2.3 ± 0.6 years. Sixty-one patients (72.6 %) had a postoperative CXR. Thirty-one (50.8 %) had no acute findings, 20 (32.8 %) had findings of atelectasis or subcutaneous emphysema, and 10 (16.4 %) had a pneumothorax. One patient (1.6 %) had a second postoperative CXR for a small pneumothorax and rib fractures. There were two complications (2.4 %). No chest tubes were placed for pneumothorax, and 95 % of patients were discharged the day of surgery.


CONCLUSIONS
Postoperative CXR following pectus bar removal is unnecessary given the low incidence of postoperative pneumothorax requiring intervention. Patients can be safely discharged the day of surgery without the need for routine postoperative chest imaging.
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, 601 5th Street South, Dept. 70-6600, 3rd Floor, Saint Petersburg, 33701, FL, USA. sfarach@comcast.net.
Sandra M
SM
Farach
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, 601 5th Street South, Dept. 70-6600, 3rd Floor, Saint Petersburg, 33701, FL, USA.
Paul D
PD
Danielson
Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, 601 5th Street South, Dept. 70-6600, 3rd Floor, Saint Petersburg, 33701, FL, USA.
Nicole M
NM
Chandler
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011182:Postoperative Care / Q000009:adverse effects; D011184:Postoperative Period; D013902:Radiography, Thoracic / Q000379:methods*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Chest radiography; Pectus bar removal; Pectus excavatum