title: Routine use of chest radiographs in the post-operative management of pectus bar removal: necessity or futility.
abstract: BACKGROUND
  While there is literature on techniques for pectus bar removal, there are limited reports on post-operative management. This can include obtaining a postoperative chest radiograph (CXR) despite the minimal risk of associated intra-thoracic complications. This is a review of our experience with bar removal and lack of routine post-operative CXR.
  
  
  METHODS
  A single institution retrospective chart review was performed from 2000 to 2015. Patients who underwent a pectus bar removal procedure were included. We assessed operative timing of bar placement and removal, procedure length, intra-operative and post-operative complications and post-operative CXR findings, specifically the rate of pneumothoraces.
  
  
  RESULTS
  450 patients were identified in this study. Median duration of bar placement prior to removal was 35 months (interquartile range 30 and 36 months). Sixtey-four patients obtained a post-operative CXR. Of these, only one (58%) film revealed a pneumothorax; this was not drained. A CXR was not obtained in 386 (86%) patients with no immediate or delayed complications from this practice. Median follow-up time for all patients was 11 months (interquartile range 7.5-17 months).
  
  
  CONCLUSIONS
  The risk for a clinically relevant pneumothorax is minimal following bar removal. This suggests that not obtaining routine imaging following bar removal may be a safe practice.
authors.affiliation: Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: Ashwini Suresh
authors.initials: AS
authors.lastname: Poola
authors.affiliation: Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Rentea
authors.affiliation: Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
authors.forename: Katrina L
authors.initials: KL
authors.lastname: Weaver
authors.affiliation: Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. sspeter@cmh.edu.
authors.forename: Shawn David
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D011030:Pneumothorax / Q000150:complications / Q000000981:diagnostic imaging; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013997:Time Factors
keywords: Bar removal; Chest radiograph; Pectus bar; Post-operative complications