Routine post-pull chest radiograph is not necessary after VATS lobectomy

Are routine, daily chest radiographs (CXR) necessary following (VATS and RATS) lobectomies?

“…Though a baseline, PACU CXR may provide a baseline reference for thoracostomy tube placement, obtaining an additional routine, POD one CXR may have low diagnostic yield in changing management particularly in the absence of abnormal clinical signs and symptoms [ [17] , [18] , [19] , [20] ]. As minimally invasive thoracic surgical techniques have become more prevalent, we are the first to define a patient population focused on minimally-invasive techniques limited to VATS and RATS lobectomies specifically [ 1 , 13 ]. We believe it is important to distinguish these techniques of classical open versus VATS/RATS as well as the operation of lobectomy and segmental resection in evaluating post-operative CXRs as these differences lead to both physiologic and clinical implications leading to diagnostic complexity.…”

“…There are no current guidelines regarding the necessity of routine, daily AM CXRs following VATS or RATS lobectomies [ [1] , [2] , [3] ]. Despite no consensus, it is common practice to obtain routine, daily AM CXRs, starting on post-operative day ( POD ) one, to guide care.…”

The significance of digital drainage devices on standardization of air leak management after pulmonary resection

“…By using a digital drainage device (Thopaz, Medela, Switzerland) to quantify air leak using the criterion of less than 20 mL/min for more than six hours for drain removal, the authors found post-removal pneumathoraces in approximately 18% of patients and post-removal pleural effusions in approximately 9% of patients on post-removal chest X-ray (CXR) ( 2 ). As these patients have undergone major anatomical pulmonary surgery, we have previously demonstrated the lack of utility in relying on post-operative CXR as post-operative changes such as subtle pneumathoraces and pleural effusions may not be as clinically reliable as evaluation of patient symptoms, regardless of an “abnormal” CXR, as they do not lead to actual changes in management ( 4 ). Thus, as the authors point out, the most clinically relevant marker to evaluate the implications of attempting earlier chest drain removal is the rate of interventions after drain removal ( 2 ).…”

“…Using their criterion using digital drainage with air leak quantification alone, their re-intervention rate was 2.1% over a period of nine years which was comparable to prior studies evaluating digital drainage and air leak ( 2 , 5 ). Though chest drain fluid output may be easily quantifiable with direct chamber measurement, there remains no consensus guidelines regarding the optimal drainage amount or even if pleural effusions seen on post-operative CXR have clinical significance as their presence does not lead to changes in management after chest drain removal ( 2 , 4 ). Thus, with the difficulty on relying on fluid output for safe chest drain removal, Abdul Khader et al highlight not only a feasible way to objectively quantify air leaks but also demonstrate its ability to allow for low complication rates after chest drain removal ( 2 ).…”