Safely Shortening the Observation Time After CT-Guided Lung Procedures

Area of Science:

• Medical Imaging
• Thoracic Surgery
• Pulmonary Medicine

Background:

• CT-guided transthoracic procedures, including lung biopsy and fiducial placement, are common.
• Immediate postprocedural pneumothorax (PTX) is a known complication.
• Current protocols often include routine follow-up chest x-rays (CXRs) for all patients.

Purpose of the Study:

• To evaluate the safety and necessity of shortened observation periods without routine follow-up CXRs.
• To determine the incidence of delayed pneumothorax (PTX) in patients without immediate PTX after CT-guided transthoracic procedures.

Main Methods:

• Retrospective review of consecutive CT-guided transthoracic procedures (lung biopsy, fiducial placement) from January 2015 to June 2017.
• Analysis of postprocedural course, complications, and clinical follow-up data from electronic medical records.
• Descriptive statistical analysis of patient outcomes.

Main Results:

• In 336 procedures without immediate PTX, 92.9% (312 patients) did not have a follow-up CXR, with a 2.2% (7 patients) rate of delayed PTX.
• Among asymptomatic patients, the overall rate of observation PTX and delayed PTX was low (0.3% and 2.2%, respectively).
• Average outpatient monitoring duration was 1.8 hours, with a low rate of PTX development during observation (4%).

Conclusions:

• Routine postprocedural CXRs are likely unnecessary for asymptomatic patients following CT-guided transthoracic procedures.
• Shortened observation times without routine CXRs appear safe due to the low incidence of delayed pneumothorax.
• Clinical monitoring for symptom development may be sufficient for selected patients.