Routine Chest X-Rays After Thoracic Surgery Are Unnecessary.

Area of Science:

• Thoracic Surgery
• Radiology
• Healthcare Quality Improvement

Background:

• Routine chest x-rays (CXRs) are frequently ordered for thoracic surgery inpatients.
• The clinical utility and impact of these routine CXRs on patient care are often unclear.
• This study investigates current CXR ordering practices and their effect on clinical decision-making in this patient population.

Purpose of the Study:

• To evaluate the clinical impact of routine chest x-rays (CXRs) ordered post-thoracic surgery.
• To assess the utility of routine CXRs performed in the postanesthesia care unit (PACU) and after chest tube (CT) removal.
• To determine if routine CXRs lead to changes in patient management or interventions.

Main Methods:

• A retrospective cohort study was conducted on adult patients undergoing thoracic surgery with chest tube placement.
• Data were collected over a one-year period, focusing on routine CXRs in the PACU and after final CT removal.
• The primary outcome measured was any change in clinical care directly driven by a routine CXR finding.

Main Results:

• Of 241 patients, all received routine PACU CXRs, with 48% showing abnormalities. Only one patient (0.4%) had a care change (repeat CXR).
• Routine CXRs after chest tube removal were performed on all patients, with 58% abnormal. 14% (33 patients) experienced a care change, primarily repeat CXRs.
• No procedural interventions were initiated based on routine CXR findings in any patient.

Conclusions:

• Routine post-thoracic surgery chest x-rays in the PACU and after chest tube removal demonstrate limited clinical impact.
• Current quality initiatives should aim to decrease the routine use of empiric CXRs.
• Ordering of CXRs should be reserved for situations with specific clinical concerns to optimize resource utilization and patient care.