The use of routine chest X-ray films after chest tube removal in postoperative cardiac patients

BACKGROUND: The use of routine postoperative chest x-ray films (CXRs) for postoperative cardiac patients has been challenged, suggesting that only clinically indicated CXRs be obtained. The removal of chest tubes has been used as an indication for CXRs. Our hypothesis is that routine postoperative chest tube removal CXRs are not indicated in the asymptomatic postoperative cardiac patient. METHODS: Charts of 1,021 consecutive postoperative median sternotomy patients were reviewed, focusing on postoperative findings of CXRs, clinical evaluations, and interventions. Those who died prior to tube removal were excluded from the study. RESULTS: Tubes were removed on postoperative days 1 to 7 (average, 1.45 days). The two groups of patients were comparable in age, gender, procedure, and co-morbidity (p > .01). Seven hundred three patients underwent routine postoperative tube removal CXRs. Abnormal findings were present in 282 patients. Resultant therapeutic intervention was undertaken in 13 patients and 9 were symptomatic. No imaging after routine postoperative CXRs was conducted in 283 patients. These patients remained asymptomatic and required no intervention. Fourteen patients had clinically indicated CXRs after chest tube removal. Two of these patients had additional tubes placed, and 1 patient had follow-up films. In total, there was a 1.5% incidence of therapeutic intervention after chest tube removal. All patients were discharged without further sequelae of their tubes. CONCLUSIONS: Omission of routine postoperative chest tube removal CXRs in postoperative cardiac patients is safe. The removal of chest tubes in these patients is not an indication for CXRs.