Routine use of chest radiographs in the post-operative management of pectus bar removal: necessity or futility.
BACKGROUND: While there is literature on techniques for pectus bar removal, there are limited reports on post-operative management. This can include obtaining a postoperative chest radiograph (CXR) despite the minimal risk of associated intra-thoracic complications. This is a review of our experience with bar removal and lack of routine post-operative CXR.
METHODS: A single institution retrospective chart review was performed from 2000 to 2015. Patients who underwent a pectus bar removal procedure were included. We assessed operative timing of bar placement and removal, procedure length, intra-operative and post-operative complications and post-operative CXR findings, specifically the rate of pneumothoraces.
RESULTS: 450 patients were identified in this study. Median duration of bar placement prior to removal was 35 months (interquartile range 30 and 36 months). Sixtey-four patients obtained a post-operative CXR. Of these, only one (58%) film revealed a pneumothorax; this was not drained. A CXR was not obtained in 386 (86%) patients with no immediate or delayed complications from this practice. Median follow-up time for all patients was 11 months (interquartile range 7.5-17 months).
DISCUSSION: The risk for a clinically relevant pneumothorax is minimal following bar removal. This suggests that not obtaining routine imaging following bar removal may be a safe practice.
Pediatric surgery international
Adolescent; Female; Follow-Up Studies; Funnel Chest; Humans; Male; Operative Time; Pneumothorax; Postoperative Care; Postoperative Complications; Radiography, Thoracic; Retrospective Studies; Time Factors
Bar removal; Chest radiograph; Chest x-ray; Pectus bar; Post-operative complications
Poola AS, Rentea RM, Weaver KL, St Peter SD. Routine use of chest radiographs in the post-operative management of pectus bar removal: necessity or futility. Pediatr Surg Int. 2017;33(5):619-622. doi:10.1007/s00383-017-4057-8