Is it safe to omit any chest x-ray before removing the chest drain after elective, non-cardiac thoracic surgery? A single-center, retrospective, case-control study.

Background Every patient undergoing non-cardiac thoracic surgery will receive several chest x-rays through the perioperative period. The patient might receive a preoperative x-ray as a baseline as well as several x-rays before and after drain removal. This routine has several disadvantages, for the patient, the health care system and the medical staff. Purpose of this study was to examine if all x-rays before removal of the drain can be omitted.

Methods & Materials 255 patients who underwent elective thoracic surgery were included in this retrospective analysis. Patients undergoing urgent procedures or empyema surgery and patients with symptoms requiring further diagnostic measures or patients who required clamping of the drain before removal were excluded.

Results 45 patients received an x-ray before removal of the drain and 210 patients did not. The x-ray group developed significantly more minor complications than the no x-ray group. 46.7% of the x-rays before drain removal (x-ray group) were reported with abnormalities. However, these abnormalities never led to a change in patient care. Drainage time and postoperative hospital stay were significantly longer in the x-ray group.

Conclusion Omitting any x-ray between surgery and removal of the chest drain appears to be safe in our retrospective patient cohort. The proposed benefits of omitting the x-ray are very relevant for the health care system, the medical and nursing teams but more importantly for the patients. Evidence suggesting to x-ray the patients regularly does not exist. It is therefore reasonable to consider exploring this question in a formal prospective trial.

Publication History

Article published online:
25 August 2025