LAUSR

Chest X-rays (CXRs) are commonly performed after removing chest tubes post-esophagectomy. However, literature on cardiopulmonary surgical patients suggests that a CXR might safely be reserved for patients who develop clinical respiratory signs or symptoms. Omitting unnecessary CXRs can save costs, radiation exposure, and logistic challenges, which aids the optimization of the postoperative care pathway. Therefore, the aim of this study was to investigate the clinical relevance of routinely performing a CXR after chest tube removal following esophagectomy. A single-center prospectively maintained database was used to select all patients who underwent esophagectomy with gastric conduit reconstruction between 2015 and 2017. Patients who received a routine CXR 4 hours after removal of at least one chest tube or thoracic Jackson-Pratt drain were included. The radiological reports of routine CXRs were retrospectively evaluated for mentioning of intrapleural air or fluid. Cases requiring re-insertion of a chest tube on the day of routine CXR or the day afterwards were identified. Furthermore, the patients’ vital parameters were retrospectively reviewed from clinical documentation. Some 118 patients were included and esophagectomy was performed by a minimally invasive transthoracic (78%), an open transthoracic (14%), or a minimally invasive transhiatal (8%) approach. A total of 231 routine CXRs were performed after the removal of chest tubes (70%) and Jackson-Pratt drains (30%). Intrapleural air was found in 78 cases (34%) and was a new finding ipsilateral to previous chest tube or drain removal in 33 cases (14%). Intrapleural fluid was mentioned in 87 cases (38), which was new and ipsilateral to previous chest tube or drain removal in 24 cases (10%). Re-insertion of a chest tube was performed in 7 cases (3%). The routine CXR prior to chest tube re-insertion had shown intrapleural air (n = 3, 1%), intrapleural fluid (n = 2, 1%), or no abnormalities (n = 2, 1%). Clinical respiratory signs or symptoms (i.e. anamnestic dyspnea, an increased respiratory rate, dropping saturation levels, or need for oxygen support) occurred in all 7 patients who required chest tube re-insertion. In conclusion, clinical respiratory signs or symptoms can safely guide the decision on whether to perform a CXR after chest tube or drain removal. All authors have declared no conflicts of interest.