F-062DAILY ROUTINE CHEST X-RAYS ARE NOT NECESSARY IN ASYMPTOMATIC PATIENTS WITH CHEST TUBE AFTER LOBECTOMY

Objectives A traditional “gold standard rule” is that a tube in the chest is an absolute indication for a daily chest X-ray (CXR), but others do not follow it. The results of these two methods in our practice are compared. Methods Data of 148 patients with “smooth” lobectomies and one drain were analysed. In the routine CXR group (R-CXR) (50 patients; operated in 2010) an immediate postoperative CXR, daily routine X-rays during the drainage period, and an X-ray after the operative drain removal were performed. In the symptomatic CXR group (S-CXR) (98 patients; operated in 2011) a CXR was performed only for symptomatic patients (repeated fever, hypoxia, enlarging subcutaneous emphysema, severe air leak) and/or only an X-ray was performed after the operative drain removal. A new drain was inserted if the result of this X-ray indicated it. The following postoperative data were compared: fever, pathologies on the X-rays (pneumothorax, fluid, atelectasis), number of X-rays, drainage time, new drain insertion. Results The mean chest tube duration times were 3.7 and 3.8 days in R-CXR and S-CXR groups, respectively. Abnormal X-ray result after the operative drain removal reported pathologies in 50% (25/50) and 46.9% (46/96) (P = 0.724), but a new drain insertion was necessary only in 3 (6%) and 7 (7.1%) (P = 0.793) cases in R-CXR and S-CXR groups, respectively. There was no significant difference in postoperative fever between the two groups (21.8% and 27.2% in RCXR and S-CXR groups, respectively). The mean number of CXRs by one patient was 5.6 and 2.3 (P = 0.0001) in R-CXR and S-CXR groups, respectively. Conclusions There were no more postoperative complications and abnormal final chest X-ray findings if the X-ray was ordered only for symptomatic patients instead of a “daily routine CXR” in the postoperative period. By the symptom-indicated CXRs, the number of roentgenograms can be reduced by 60%. Disclosure All authors have declared no conflicts of interest.