2012 annual meeting & cardiothoracic forum - Society for ...

ACTA-SCTS JOINT MEETING • Manchester Central Conference Centre
192 Timing of Chest X-ray Following Thorascopic Sympathectomy can
Avoid Unnecessary Drain Placement and Radiation Exposure
Authors: Beattie; R. M. Jones
Royal Victoria Hospital, United Kingdom
Objectives: Carbon dioxide (CO2) insufflation is used during thoracoscopic
sympathectomy to optimise surgical view. The solubility of CO2 allows it to be
quickly absorbed, but the lag time means that early chest x-ray (CXR) may result in
unnecessary interventions to the patient, including further radiation and chest
drainage.
Methods: The regional thoracic surgery database was interrogated comparing the
time from leaving theatre to the first post operative chest film. This was reviewed
for a pneumothorax, and subsequent films were reviewed for resolution of the
pneumothorax, placement of an underwaterseal drain and for the total number of
CXRs during that admission.
Results: One hundred and seventy patients were identified with median age of
27years. 65% were female and 25% were smokers. The most common diagnoses
were hyperhydrosis axillaris and palmaris comprising 87% of the patients. There
were no tension pneumothoraces, no haemothoraces, no conversions to an open
procedure but one chylothorax. 40 patients (23.5%) had a pneumothorax identified
and 25% received a drain. The median number of CXRs post operatively was 1
(range1-18). If the CXR was taken in the first hour postop the chance of diagnosing
a pneumothorax was 6.5%, this fell to 2.9% the subsequent 2 hours to 1.8% by the
5th postop hour. If a pneumothorax was diagnosed in the first two hours, 31% of
these patients received a chest drain. If the diagnosis was made after two hours,
only 20% of this group received a drain.
Conclusions: Taking a CXR within two hours post op is associated with a higher
diagnosis of pneumothorax and subsequent drainage. Leaving the CXR until the 5th
post operative hour is safe, it reduces the risk of diagnosing a carbon dioxide
pneumothorax and subsequent drain insertion, yet still identifies pneumothoraces
that may require treatment.
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