Abstract
Background
Pleural drains are routinely used following anterior approaches to the spine for the correction of spinal deformities, to prevent the accumulation of blood, fluids and air in the pleural cavity. Following their removal it is routine practise in our Trust to obtain chest radiographs to look out for a pneumothorax or a residual fluid collection. Our hypothesis is that unless clinically indicated the use of a CXR does not affect patient management and should not therefore be routine practice.
Methods
A retrospective audit of 122 consecutive patients, who underwent surgery for the correction of spinal deformity using an anterior approach to the spine, over the course of a year, was undertaken. CXRs were performed in all patients following drain removal. We have reviewed those images and in cases were abnormalities were detected we have examined the case notes to assess the impact of those findings with regards to management.
Results
122 patients (92F,30M) were included in our study. Mean age was 20.1 yyears. There were records of pre existing lung pathology in 4 cases. The right and left pleura were opened in 99 and 23 cases respectively and a chest drain was inserted in all cases peri operatively. The average time for removal was 4.2 days. There were 27 cases were an insignificant abnormality was detected. There were 2 cases were a large pneumothorax (>2cm) was detected. On reviewing these case notes there were abnormalities in clinical parameters and abnormal findings on clinical examination that would alert the clinician to the possibility of underlying pathology and the need for further evaluation. In all cases there was no further intervention in the form of chest drain re insertion.
Conclusion
There is a very low incidence of pneumothorax following pleural drain removal. Those cases can be identified by means of clinical evaluation. The use of routine CXR is not necessary. This is a safe cost effective intervention that will also serve to reduce the radiation patients are subjected to.
Ethics approval Audit/service standard in trust
Interest StatementNone
