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

There is no consensus on postoperative thoracostomy tube management in thoracic patients, specifically whether or not a chest radiograph is required after tube removal.

Retrospective review of video-assisted thoracoscopic (VATS) lobectomy patients was performed at a large tertiary referral center from January 1, 2019 to December 31, 2020. Patients were grouped as asymptomatic or symptomatic after thoracostomy removal. Demographic data and clinical outcomes were evaluated. Descriptive statistics, Fisher's exact and Wilcoxon rank sum tests were performed.

202 of 208 patients were asymptomatic after thoracostomy removal. Demographic data between those who were asymptomatic and symptomatic revealed no differences except for a higher FEV1/FVC in the asymptomatic group. Median length of stay for asymptomatic and symptomatic patients was 2.0 and 3.5 (p=0.295). 62% of asymptomatic versus 100% of symptomatic patients had abnormal post-pull radiographs (p=0.088). No one in the asymptomatic group required an intervention after thoracostomy removal and prior to discharge whereas 66.7% in the symptomatic group required a procedure (p<0.0001).

Our study revealed that rather than abnormal radiography, presence of symptoms correlated with the need for further intervention. Notably, many of our patients had abnormal post-pull radiographs but did not develop symptoms and were successfully discharged without complication. Only patients with symptoms required an intervention after thoracostomy removal.

Patient symptoms, not radiographic findings, determine the need for intervention after thoracostomy removal in VATS lobectomy patients. Post-pull chest radiographs may not need to be obtained if the patients have no clinical symptoms and signs.