Routine chest X-rays after the removal of chest tubes are not necessary following esophagectomy

Abstract

Background: Chest X-rays (CXRs) are commonly performed after removing chest tubes following surgery. However, the value of this practice is unclear for patients who underwent esophagectomy. Therefore, the aim of this study was to investigate the clinical relevance of routinely performing a CXR after chest tube removal during the postoperative course of esophagectomy. Methods: A single-center prospective database was used to select all patients who underwent esophagectomy with gastric conduit reconstruction between 2015 and 2017. Patients who received a CXR within 4 hours after removal of at least one chest tube were included. The radiological reports of these CXRs were evaluated for intrapleural air and fluid. Cases requiring re-insertion of a chest tube on the day of CXR or the day afterwards were identified and the clinical situation of these patients was reviewed. Results: Some 117 patients were included and a total of 231 chest tube removals were followed by a CXR within 4 hours. Re-insertion of a chest tube was performed in a total of 6 cases (3%) on the day or the day after this CXR. All these 6 patients had clinical signs or symptoms indicating respiratory problems. In total, new intrapleural air was found on the ipsilateral side of previous chest tube removal in 33 cases (14%) and new intrapleural fluid occurred on the ipsilateral side of previous chest tube removal in 24 cases (10%). Conclusions: In conclusion, a CXR after chest tube removal may safely be reserved for patients who develop clinical signs or symptoms that indicate respiratory problems.