P-141CHEST X-RAY PRIOR TO DISCHARGE AFTER VIDEO-ASSISTED THORACIC ANATOMICAL PULMONARY RESECTION. FRIEND OR FOE?

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (suppl_1), p.S37-S37
• Main Authors: Troquay, Stephanie, von Meyenfeldt, E., Vissers, Y., Bootsma, G., Siebenga, J.
• Format: Article
• Language: English
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.141

Objectives We aimed to evaluate the benefit of a chest X-ray in clinically fit patients prior to discharge from hospital after a video-assisted thoracic surgery (VATS) anatomical resection. Will possible early detection of complications outweigh potential overtreatment? Do thoracic surgeons and chest physicians differ in their interpretation of these X-rays? Methods A retrospective chart study was performed of all elective VATS anatomical resections between January and November 2012 (n − 86). A chest X-ray was taken in 35 patients deemed clinically fit for discharge. Since these X-rays were intended as a baseline for follow-up, they were not viewed during the hospital stay. Whether an in-hospital baseline X-ray was performed was not protocolised. All X-rays, demographics, procedural details and 30-day follow-up were retrieved. No significant differences were found between the 35 and the remaining 51 patients. Two chest physicians and 2 thoracic surgeons were asked whether they would discharge a patient based on their X-ray, considering there were no clinical contraindications. Sensitivity and specificity for predicting complications were calculated per physician. To assess inter-observer agreement Cohen's Kappa was calculated. Results During 30-day follow-up one bronchopleural fistula and one pneumothorax occurred. Thoracic surgeon 1 scored a sensitivity of 100% detecting patients with complications, specificity of 58%. Thoracic surgeon 2; sensitivity 0%, specificity 97%. Kappa -0.165 (no agreement). Chest physician 1: sensitivity 50%, specificity 85%. Pulmonary medicine resident: sensitivity 100%, specificity 79%. Kappa 0.236 (fair agreement). The generalised Kappa, estimating agreement among the four was 0.163 (slight agreement). Conclusions Varied sensitivity rates and only slight agreement between physicians were found based on their chest X-ray. In our retrospective series, a chest X-ray, therefore, is an unreliable tool to predict complications. This, combined with the low specificity, potentially resulting in unnecessarily prolonged hospital stay and possibly overtreatment, makes a chest X-ray in a clinically fit patient a foe. Disclosure All authors have declared no conflicts of interest.