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

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Diagnostic Imaging

Background:

• Lack of consensus guidelines for post-operative imaging after thoracic surgery.
• Efficacy of daily chest radiographs (CXRs) post-video-assisted (VATS) and robotic-assisted (RATS) thoracoscopic surgery is unstudied.
• Need to determine if clinical findings or imaging better predict complications.

Purpose of the Study:

• To investigate whether abnormal clinical findings or abnormal chest radiographs (CXRs) better predict post-operative complications after VATS/RATS lobectomies.
• To evaluate the necessity of routine post-operative imaging in directing management.
• To identify predictors for procedural requirements and extended length of stay (LOS).

Main Methods:

• Retrospective review of 362 VATS/RATS lobectomy patients (1/1/2019-12/31/2021).
• Evaluation of demographics, hospital course, and imaging.
• Statistical analysis including Chi-Square, Fisher's exact, Wilcoxon rank sum, and multivariable logistic regression.

Main Results:

• 15 patients (4.1%) experienced post-operative complications requiring procedures.
• Abnormal clinical signs/symptoms predicted procedural requirement (OR=48), while abnormal post-operative day one CXRs did not.
• Positive smoking history, number of CXRs, and thoracostomy tubes predicted extended LOS, but clinical signs/symptoms did not.

Conclusions:

• Abnormal clinical findings are more predictive of post-operative complications requiring procedures than abnormal CXRs after VATS/RATS.
• Routine post-operative CXRs may be unnecessary for patients without clinical signs or symptoms.
• Clinical assessment is crucial for guiding management decisions post-minimally invasive thoracic lobectomy.