Our Summary

This research paper questions the routine use of chest X-rays after the removal of chest drains in patients who have undergone cardiac and thoracic surgeries. The concern is that these routine X-rays expose patients to unnecessary radiation, increase healthcare costs, and overuse resources.

The researchers reviewed 375 studies and found that the incidence of pneumothorax (a collapsed lung) is less than 10% in adult cardiac patients and children who have had cardiac and thoracic surgery. In adults who have had thoracic surgery, the incidence could be as high as 50%. However, the need for further intervention is less than 2% across all these groups.

The researchers suggest that doctors should base the need for a chest X-ray on the development of respiratory and cardiovascular symptoms rather than making it a routine procedure. They also propose that bedside ultrasounds could be used instead of X-rays to detect pneumothorax, as this method does not expose patients to radiation.

FAQs

  1. What is the main concern of the research paper about routine chest X-rays after cardiac and thoracic surgeries?
  2. What alternative does the research suggest to replace routine chest X-rays after cardiac and thoracic surgeries?
  3. What is the incidence of pneumothorax in adult cardiac patients and children who have had cardiac and thoracic surgery according to the study?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about thoracic surgery is to only get a chest X-ray if they are experiencing respiratory or cardiovascular symptoms, rather than automatically scheduling one after the removal of chest drains. This can help reduce unnecessary radiation exposure and healthcare costs. Additionally, patients can inquire about the possibility of using bedside ultrasounds as an alternative method for detecting potential complications.

Suitable For

Patients who have undergone cardiac and thoracic surgeries are typically recommended for thoracic surgery if they develop respiratory or cardiovascular symptoms that may indicate complications such as pneumothorax. This includes adult cardiac patients, children who have had cardiac and thoracic surgery, and adults who have had thoracic surgery.

It is important for healthcare providers to carefully evaluate the need for thoracic surgery based on the individual patient’s symptoms and clinical presentation, rather than routinely ordering chest X-rays after the removal of chest drains. This approach can help reduce unnecessary radiation exposure, healthcare costs, and resource utilization, while still ensuring that patients receive appropriate care and intervention when needed.

Timeline

Before thoracic surgery:

  • Patient consults with a thoracic surgeon to discuss the need for surgery and potential risks and benefits
  • Pre-operative testing and imaging are conducted to evaluate the patient’s overall health and the extent of the condition requiring surgery
  • Patient undergoes anesthesia and the surgery is performed
  • Chest drains are inserted to remove excess fluid or air from the chest cavity
  • Post-operative monitoring and pain management are provided to the patient

After thoracic surgery:

  • Patient is monitored in the intensive care unit (ICU) or a surgical ward for a period of time to ensure stability
  • Chest drains are removed once drainage decreases to a certain level
  • Routine chest X-rays may be ordered to monitor for any complications, such as pneumothorax
  • Patient undergoes physical therapy and rehabilitation to regain strength and mobility
  • Follow-up appointments are scheduled with the surgeon to monitor healing and address any concerns or complications

Overall, the recovery process after thoracic surgery can vary depending on the individual patient and the extent of the surgery. It is important for patients to follow their healthcare provider’s instructions for post-operative care to ensure a successful recovery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with thoracic surgery?
  2. What is the expected recovery time and rehabilitation process after thoracic surgery?
  3. Are there any alternative treatment options to thoracic surgery that I should consider?
  4. How many thoracic surgeries have you performed, and what is your success rate?
  5. What specific procedure will be performed during the thoracic surgery, and what are the potential outcomes?
  6. What type of anesthesia will be used during the surgery, and what are the potential side effects?
  7. How long will I need to stay in the hospital after the surgery, and what is the post-operative care plan?
  8. What are the potential long-term effects or complications of thoracic surgery that I should be aware of?
  9. Will I need any follow-up appointments or additional treatments after the surgery?
  10. What can I do to prepare for the thoracic surgery and optimize my chances of a successful outcome?

Reference

Authors: Thet MS, Han KPP, Hlwar KE, Thet KS, Oo AY. Journal: J Card Surg. 2022 Dec;37(12):5320-5325. doi: 10.1111/jocs.17114. Epub 2022 Nov 6. PMID: 36335600