Clinical value of routine chest X-ray after thoracoscopic lung resection: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Xianglin ¹ , TANG Dezhao ² , CHEN Yizhang ² , WU Junhan ³ ,  QIAO Guibin ⁴ , SHI Qiuling ⁵

1. Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510060, P. R. China;
2. The Second School of Clinical Medicine, Southern Medical University, Guangdong Provincial People's Hospital, Guangzhou, 510515, P. R. China;
3. Shantou University Medical College, Guangdong Provincial People's Hospital, Guangzhou, 510060, P. R. China;
4. Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 5100060, P. R. China;
5. School of Public Health, Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding author：

QIAO Guibin, Email: guibinqiao@126.com

Keywords：

Chest X-ray examination; video-assisted lung resection; patient-reported outcomes; postoperative outcomes

DOI：

10.7507/1007-4848.202408037

Video：

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Objective To explore the necessity of routine X-ray examination after lung surgery based on patient symptom burden. Methods A retrospective study was conducted including patients underwent thoracoscopic lung resection in the Department of Thoracic Surgery at uangdong Provincial People's Hospital from March 2020 to April 2023. Symptom burden was evaluated using the Perioperative Symptom Assessment Lung inventory. Results A total of 2 101 patients were included in the analysis. The median age was 56 years and 52.3% of included patients were female. Among patients who underwent routine postoperative chest X-ray, only 1% patients accepted intervention. Among patients who had chest X-ray after chest tube removal, only 0.5% of them needed intervention. Among patients who had chest X-ray one month after discharge, only 1.3% of them required intervention. The intervention group had significantly worse shortness of breath (3 vs. 2, P<0.05), pain (2 point vs. 1 point, P=0.039), and disturbed sleep (3 vs. 2, P<0.05) compared with the normal group. Conclusion Very few routine postoperative chest X-ray examinations changed patients’ management, and patients who needed extra intervention tended to have more severe symptom burden after surgery.

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2.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3.	Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
4.	Zhou L, Zhang Y, Chen W, et al. Development and validation of a prognostic nomogram for early stage non-small cell lung cancer: A study based on the SEER database and a Chinese cohort. BMC Cancer, 2022, 22(1): 980.
5.	Dai W, Feng W, Zhang Y, et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: A multicenter randomized controlled trial. J Clin Oncol, 2022, 40(9): 988-996.
6.	Zhang H, Zeng J, Li X, et al. The nomogram for the prediction of overall survival after surgery in patients in early-stage NSCLC based on SEER database and external validation cohort. Cancer Med, 2024, 13(1): e6751.
7.	Hong YJ, Han S, Lim JU, et al. Association between quality of life questionnaire at diagnosis and survival in patients with lung cancer. Clin Lung Cancer, 2023, 24(5): 459-466.
8.	Yu Q, Yu H, Xu W, et al. Shortness of breath on day 1 after surgery alerting the presence of early respiratory complications after surgery in lung cancer patients. Patient Prefer Adherence, 2022, 16: 709-722.
9.	Kamel MK, Lee B, Harrison SW, et al. Sublobar resection is comparable to lobectomy for screen-detected lung cancer. J Thorac Cardiovasc Surg, 2022, 163(6): 1907-1915.
10.	Kamel MK, Lee B, Harrison S, et al. Do the surgical results in the national lung screening trial reflect modern thoracic surgical practice? J Thorac Cardiovasc Surg, 2019, 157(5): 2038-2046.
11.	Galata C, Cascant Ortolano L, Shafiei S, et al. Are routine chest X-rays necessary following thoracic surgery? A systematic literature review and meta-analysis. Cancers (Basel), 2022, 14(18): 4361.
12.	Malík M, Dzian A, Skaličanová M, et al. Chest ultrasound can reduce the use of roentgenograms in postoperative care after thoracic surgery. Ann Thorac Surg, 2021, 112(3): 897-904.
13.	Nagy P, Antony C, Hegedüs B, et al. Same-day routine chest-X ray after thoracic surgery is not necessary! Zentralbl Chir, 2018, 143(1): 96-101.
14.	Kröner A, Beenen L, du Raan M, et al. The clinical value of routinely obtained postoperative chest radiographs in post-anaesthesia care unit patients seems poor-a prospective observational study. Ann Transl Med, 2018, 6(18): 360.
15.	McGrath E, Ranstrom L, Lajoie D, et al. Is a chest radiograph required after removal of chest tubes in children? J Pediatr Health Care, 2017, 31(5): 588-593.
16.	Johnson B, Rylander M, Beres AL. Do X-rays after chest tube removal change patient management? J Pediatr Surg, 2017, 52(5): 813-815.
17.	Porter ED, Fay KA, Hasson RM, et al. Routine chest X-rays after thoracic surgery are unnecessary. J Surg Res, 2020, 250: 188-192.
18.	Beattie G, Cohan CM, Chomsky-Higgins K, et al. Is a chest radiograph after thoracostomy tube removal necessary? A cost-effective analysis. Injury, 2020, 51(11): 2493-2499.
19.	Esposito R, Conklin M, McGwin G, et al. Do we need postoperative chest radiographs after posterior spinal fusion for adolescent idiopathic scoliosis? Spine Deform, 2019, 7(4): 571-576.
20.	Porter ED, Kelly JL, Fay KA, et al. Reducing unnecessary chest x-ray films after thoracic surgery: A quality improvement initiative. Ann Thorac Surg, 2021, 111(3): 1012-1018.
21.	Feng Y, Dai W, Wang Y, et al. Comparison of chief complaints and patient-reported symptoms of treatment-naive lung cancer patients before surgery. Patient Prefer Adherence, 2021, 15: 1101-1106.
22.	Heidel JS, Miller J, Donovan E, et al. Routine chest radiography after thoracostomy tube removal and during postoperative follow-up is not necessary after lung resection. J Thorac Cardiovasc Surg, 2024, 167(2): 517-525.
23.	Retzer A, Aiyegbusi OL, Rowe A, et al. The value of patient-reported outcomes in early-phase clinical trials. Nat Med, 2022, 28(1): 18-20.
24.	Basch E. The missing voice of patients in drug-safety reporting. N Engl J Med, 2010, 362(10): 865-869.
25.	U. S. Department of Health and Human Services FDA Center for Drug Evaluation and Research. Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance. Health Qual Life Outcomes, 2006, 4: 79.
26.	Basch E, Mody GN, Dueck AC. Electronic patient-reported outcomes as digital therapeutics to improve cancer outcomes. JCO Oncol Pract, 2020, 16(9): 541-542.
27.	28th annual conference of the international society for quality of life research. Qual Life Res, 2021, 30(Suppl 1): 1-177.
28.	Malík M, Dzian A, Števík M, et al. Lung ultrasound reduces chest X-rays in postoperative care after thoracic surgery: Is there a role for artificial intelligence?-Systematic review. Diagnostics (Basel), 2023, 13(18): 2995.
29.	Galetin T, Defosse J, Schieren M, et al. Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery. Eur J Cardiothorac Surg, 2020, 57(5): 846-853.
30.	Burel J, El Ayoubi M, Baste JM, et al. Surgery for lung cancer: Postoperative changes and complications-what the radiologist needs to know. Insights Imaging, 2021, 12(1): 116.
31.	Bjerregaard LS, Jensen K, Petersen RH, et al. Routinely obtained chest X-rays after elective video-assisted thoracoscopic surgery can be omitted in most patients; a retrospective, observational study. Gen Thorac Cardiovasc Surg, 2015, 63(8): 465-471.
32.	Zukowski M, Haas A, Schaefer EW, et al. Are routine chest radiographs after chest tube removal in thoracic surgery patients necessary? J Surg Res, 2022 Aug: 276: 160-167.276-160.
33.	Dezube AR, Deeb A, De Leon LE, et al. Routine chest roentgenogram after chest tube removal is not indicated for minimally invasive lung resection. Ann Thorac Surg, 2022, 114(6): 2108-2114.
34.	Bhatt AS, Schabath MB, Hoogland AI, et al. Patient-reported outcomes as interradiographic predictors of response in non-small cell lung cancer. Clin Cancer Res, 2023, 29(16): 3142-3150.
35.	Zhang J, Su X, Xu W, et al. Identifying patients who suffered from post-discharge cough after lung cancer surgery. Support Care Cancer, 2022, 30(9): 7705-7713.
36.	Tang L, Yu H, Dai W, et al. Symptom trajectories informing patient care after lung cancer surgery: A longitudinal patient-reported outcome study. Ann Surg Oncol, 2023, 30(5): 2607-2617.

1. Lim E, Harris RA, McKeon HE, et al. Impact of video-assisted thoracoscopic lobectomy versus open lobectomy for lung cancer on recovery assessed using self-reported physical function: VIOLET RCT. Health Technol Assess, 2022, 26(48): 1-162.
2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
3. Odor PM, Bampoe S, Gilhooly D, et al. Perioperative interventions for prevention of postoperative pulmonary complications: Systematic review and meta-analysis. BMJ, 2020, 368: m540.
4. Zhou L, Zhang Y, Chen W, et al. Development and validation of a prognostic nomogram for early stage non-small cell lung cancer: A study based on the SEER database and a Chinese cohort. BMC Cancer, 2022, 22(1): 980.
5. Dai W, Feng W, Zhang Y, et al. Patient-reported outcome-based symptom management versus usual care after lung cancer surgery: A multicenter randomized controlled trial. J Clin Oncol, 2022, 40(9): 988-996.
6. Zhang H, Zeng J, Li X, et al. The nomogram for the prediction of overall survival after surgery in patients in early-stage NSCLC based on SEER database and external validation cohort. Cancer Med, 2024, 13(1): e6751.
7. Hong YJ, Han S, Lim JU, et al. Association between quality of life questionnaire at diagnosis and survival in patients with lung cancer. Clin Lung Cancer, 2023, 24(5): 459-466.
8. Yu Q, Yu H, Xu W, et al. Shortness of breath on day 1 after surgery alerting the presence of early respiratory complications after surgery in lung cancer patients. Patient Prefer Adherence, 2022, 16: 709-722.
9. Kamel MK, Lee B, Harrison SW, et al. Sublobar resection is comparable to lobectomy for screen-detected lung cancer. J Thorac Cardiovasc Surg, 2022, 163(6): 1907-1915.
10. Kamel MK, Lee B, Harrison S, et al. Do the surgical results in the national lung screening trial reflect modern thoracic surgical practice? J Thorac Cardiovasc Surg, 2019, 157(5): 2038-2046.
11. Galata C, Cascant Ortolano L, Shafiei S, et al. Are routine chest X-rays necessary following thoracic surgery? A systematic literature review and meta-analysis. Cancers (Basel), 2022, 14(18): 4361.
12. Malík M, Dzian A, Skaličanová M, et al. Chest ultrasound can reduce the use of roentgenograms in postoperative care after thoracic surgery. Ann Thorac Surg, 2021, 112(3): 897-904.
13. Nagy P, Antony C, Hegedüs B, et al. Same-day routine chest-X ray after thoracic surgery is not necessary! Zentralbl Chir, 2018, 143(1): 96-101.
14. Kröner A, Beenen L, du Raan M, et al. The clinical value of routinely obtained postoperative chest radiographs in post-anaesthesia care unit patients seems poor-a prospective observational study. Ann Transl Med, 2018, 6(18): 360.
15. McGrath E, Ranstrom L, Lajoie D, et al. Is a chest radiograph required after removal of chest tubes in children? J Pediatr Health Care, 2017, 31(5): 588-593.
16. Johnson B, Rylander M, Beres AL. Do X-rays after chest tube removal change patient management? J Pediatr Surg, 2017, 52(5): 813-815.
17. Porter ED, Fay KA, Hasson RM, et al. Routine chest X-rays after thoracic surgery are unnecessary. J Surg Res, 2020, 250: 188-192.
18. Beattie G, Cohan CM, Chomsky-Higgins K, et al. Is a chest radiograph after thoracostomy tube removal necessary? A cost-effective analysis. Injury, 2020, 51(11): 2493-2499.
19. Esposito R, Conklin M, McGwin G, et al. Do we need postoperative chest radiographs after posterior spinal fusion for adolescent idiopathic scoliosis? Spine Deform, 2019, 7(4): 571-576.
20. Porter ED, Kelly JL, Fay KA, et al. Reducing unnecessary chest x-ray films after thoracic surgery: A quality improvement initiative. Ann Thorac Surg, 2021, 111(3): 1012-1018.
21. Feng Y, Dai W, Wang Y, et al. Comparison of chief complaints and patient-reported symptoms of treatment-naive lung cancer patients before surgery. Patient Prefer Adherence, 2021, 15: 1101-1106.
22. Heidel JS, Miller J, Donovan E, et al. Routine chest radiography after thoracostomy tube removal and during postoperative follow-up is not necessary after lung resection. J Thorac Cardiovasc Surg, 2024, 167(2): 517-525.
23. Retzer A, Aiyegbusi OL, Rowe A, et al. The value of patient-reported outcomes in early-phase clinical trials. Nat Med, 2022, 28(1): 18-20.
24. Basch E. The missing voice of patients in drug-safety reporting. N Engl J Med, 2010, 362(10): 865-869.
25. U. S. Department of Health and Human Services FDA Center for Drug Evaluation and Research. Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims: Draft guidance. Health Qual Life Outcomes, 2006, 4: 79.
26. Basch E, Mody GN, Dueck AC. Electronic patient-reported outcomes as digital therapeutics to improve cancer outcomes. JCO Oncol Pract, 2020, 16(9): 541-542.
27. 28th annual conference of the international society for quality of life research. Qual Life Res, 2021, 30(Suppl 1): 1-177.
28. Malík M, Dzian A, Števík M, et al. Lung ultrasound reduces chest X-rays in postoperative care after thoracic surgery: Is there a role for artificial intelligence?-Systematic review. Diagnostics (Basel), 2023, 13(18): 2995.
29. Galetin T, Defosse J, Schieren M, et al. Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery. Eur J Cardiothorac Surg, 2020, 57(5): 846-853.
30. Burel J, El Ayoubi M, Baste JM, et al. Surgery for lung cancer: Postoperative changes and complications-what the radiologist needs to know. Insights Imaging, 2021, 12(1): 116.
31. Bjerregaard LS, Jensen K, Petersen RH, et al. Routinely obtained chest X-rays after elective video-assisted thoracoscopic surgery can be omitted in most patients; a retrospective, observational study. Gen Thorac Cardiovasc Surg, 2015, 63(8): 465-471.
32. Zukowski M, Haas A, Schaefer EW, et al. Are routine chest radiographs after chest tube removal in thoracic surgery patients necessary? J Surg Res, 2022 Aug: 276: 160-167.276-160.
33. Dezube AR, Deeb A, De Leon LE, et al. Routine chest roentgenogram after chest tube removal is not indicated for minimally invasive lung resection. Ann Thorac Surg, 2022, 114(6): 2108-2114.
34. Bhatt AS, Schabath MB, Hoogland AI, et al. Patient-reported outcomes as interradiographic predictors of response in non-small cell lung cancer. Clin Cancer Res, 2023, 29(16): 3142-3150.
35. Zhang J, Su X, Xu W, et al. Identifying patients who suffered from post-discharge cough after lung cancer surgery. Support Care Cancer, 2022, 30(9): 7705-7713.
36. Tang L, Yu H, Dai W, et al. Symptom trajectories informing patient care after lung cancer surgery: A longitudinal patient-reported outcome study. Ann Surg Oncol, 2023, 30(5): 2607-2617.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesClinical value of routine chest X-ray after thoracoscopic lung resection: A retrospective cohort study

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