Is postoperative routine thoracic imaging necessary to detect thoracic complications in patients undergoing...

Supracostal access during percutaneous nephrolithotomy (PCNL) increases the risk of pulmonary complications. Although routine postoperative thoracic imaging is commonly performed to detect these events, its clinical necessity remains controversial. This study aimed to assess the necessity of routine postoperative thoracic imaging for detecting pulmonary complications in patients undergoing supracostal mini percutaneous nephrolithotomy (m-PCNL) surgery.

A retrospective analysis was conducted on data from patients who underwent supracostal m-PCNL between 2017 and 2022 in a tertiary center. Excluding patients under 18, with kidney/skeletal anomalies, or active thoracic disease, 112 eligible patients were included. Patients were divided into two groups: those with routine postoperative chest X-ray (CXR) (Group 1, n = 40) and those without (Group 2, n = 72). Complications and operative data were compared between groups.

Mean ages were 44.3 ± 11.4 (Group 1) and 42.6 ± 13.1 (Group 2), with no significant difference (p = 0.102). Stone sizes were 30.8 ± 8.6 mm (Group 1) and 24.8 ± 8.4 mm (Group 2), also not significantly different (p = 0.313). High fever occurred in 10% of Group 1 and 4% of Group 2 (p = 0.246). Minimal effusion was found in 10% of Group 1, with no treatment due to lack of symptoms. However, subsequent CXR revealed hydropneumothorax in 2.5% of cases, necessitating thoracic tube insertion. In Group 2, 5% developed postoperative respiratory symptoms, with significant pneumothorax in 1.3%, requiring thoracic tube placement. Thoracic tube insertion rates did not significantly differ between groups (Group 1: 2.5% vs. Group 2: 1.3%, p = 0.671).

Routine postoperative thoracic imaging did not show any significant benefit in detecting pulmonary complications post-supracostal m-PCNL.