C77-47 The Impact Of Recovery Achievement On The Value Of Post-tube Chest X-ray After Chest Tube Removal Following Robotic Lung Resection

Background

An additional CXR following chest tube removal can help confirm no significant changes following removal. We hypothesize that an additional, post-pull CXR (PP CXR) following chest tube removal provides little benefit to patient outcomes and increases cost of care. This study aims to assess the utility of CXR following chest tube removal following minimally invasive thoracoscopic surgery stratified by recovery achievement.

Methods

We performed a retrospective analysis of a prospectively maintained ERAS database of patients undergoing robotic lobectomy, segmentectomy, or wedge resection. Patients were stratified into three achievement recovery groups: accelerated recovery (AR) on POD1, targeted recovery (TR) on POD2-3, and delayed recovery (DR) on POD4+. Preoperative and perioperative variables, ERAS achievements, complications, and reinterventions after chest tube removal were analyzed. Inclusion criteria were patients undergoing lung resection surgery due to cancer diagnosis. Exclusion criteria was any patient that was discharged home with a chest tube in place.

Results

A total of 502 consecutive patients were included in the data analysis. 241 (48%) achieved AR, 210 (41.8%) TR, and only 51 (10.2%) DR. The need for reimaging following PP CXR increased over the recovery groups; 3.3% (AR) , 6.6% (TR) , and 13.7% (DR) (p = 0.01) . This led to increased need for reintervention based on recovery achievement as well; 1.2% (AR), 3.8% (TR), and 7.8% (DR) (p = 0.03).

Conclusion

Post-pull chest radiography before discharge following chest tube removal after robotic lung resection provides value in TR and DR patients, but can be omitted in patients achieving AR, POD 1 discharge.

This abstract is funded by: None