Elimination of routine chest X-rays after lung resection: a quality improvement initiative.

BACKGROUND

Performing a postoperative chest X-ray (CXR) is a routine practice following lung surgery. Despite studies suggesting that CXRs may be unnecessary for most patients, no initiative has been taken to discontinue this practice. Our initiative aims to discontinue routine CXR after lung resections and evaluate the safety of this approach to improve the quality of care.

METHODS

We conducted a single-center, retrospective, controlled before-after study. Patients who underwent lung resection between January 2022 and May 2023, excluding pneumonectomy and spontaneous pneumothorax, were included. Before the initiative, patients received routine CXRs immediately after surgery, after chest tube removal, and during outpatient follow-up. After implementation, CXRs were only performed based on clinical indications from the medical team. We compared 30-day readmission rates before and after the discontinuation of routine CXRs, along with cardiopulmonary complications, hospital stay length, and reoperations. Additional analyses were performed 10 months post-initiative to monitor practice evolution.

RESULTS

A total of 128 patients (64 in each group) were included. The total number of CXRs decreased from 247 to 109 after the initiative. Of the CXRs conducted post-implementation, a significant proportion were performed by error, and only 28.1% of patients no longer received CXRs. There were no significant differences in 30-day readmission rates (14.1% vs. 4.8%, P=0.07) or cardiopulmonary complications (30.1% vs. 23.4%, P=0.39). After 10 months, 77.2% of patients no longer received postoperative CXRs, with a 0% readmission rate.

CONCLUSIONS

Eliminating routine postoperative CXRs after lung resection is safe, though transitioning to this practice requires time and confidence-building.