title: The Interest of Performing "On-Demand Chest X-rays" after Lung Resection by Minimally Invasive Surgery.
abstract: BackgroundThere is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice.MethodsThis prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization.ResultsThe length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7).ConclusionOn-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity-mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus.
authors.affiliation: Unit of Thoracic Surgery, University Hospital of Rouen, Rouen, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Haddad
authors.affiliation: Unit of Biostatistic, University Hospital of Rouen, Rouen, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Bubenheim
authors.affiliation: Unit of Thoracic Surgery, University Hospital of Dijon, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Unit of Thoracic Surgery, University Hospital of Rouen, Rouen, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Melki
authors.affiliation: Unit of Thoracic Surgery, University Hospital of Rouen, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Peillon
authors.affiliation: Unit of Thoracic Surgery, University Hospital of Rouen, Rouen, France.|Inserm U1096, Rouen Institute for Research and Innovation in Biomedicine, Rouen, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Baste
mesh_terms: D000368:Aged; D015505:Chest Tubes; D004322:Drainage / Q000295:instrumentation; D005602:France; D006301:Health Services Needs and Demand; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013902:Radiography, Thoracic; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome