Is routine postoperative chest radiography needed after open nephrectomy?

OBJECTIVES: To assess whether routine postoperative chest radiography (CXR) is required after open nephrectomy for the detection and possible management of a pneumothorax. It has become the standard of care by many urologists to obtain routine postoperative CXRs after open nephrectomy to assess for the presence of a pneumothorax. However, at our institution, very few patients have developed a pneumothorax postoperatively, and, furthermore, the CXR findings almost never affected the clinical management.

METHODS: Retrospective data were collected on the last 150 open nephrectomies performed by two urologists at our institution. All laparoscopic nephrectomies and thoracoabdominal nephrectomies were excluded from analysis.

RESULTS: A total of 150 patients underwent open nephrectomy between 1998 and 2003. The procedure was performed with an anterior subcostal, 11th rib, 12th rib, midline, and 10th rib incision in 60 (40%), 51 (34%), 18 (12%), 20 (13.3%), and 1 (0.67%) patient, respectively. Of the 150 patients, 92 (61.3%) underwent postoperative CXR and 58 (38.7%) did not. Of the 150 patients, 92 of whom had undergone postoperative CXR, 4 (2.7%) had a postoperative pneumothorax. One of these patients (0.67%) received a chest tube. Of the 4 patients with a pneumothorax, 3 had had a recognized pleural tear that was repaired at nephrectomy and the fourth had had an unrecognized pleural injury.

CONCLUSIONS: Routine postoperative CXRs are not needed after open nephrectomy. Obtaining a selective CXR when a recognized intraoperative pleural tear has occurred, a central line is placed, the physical examination reveals an abnormality (ie, decreased breath sounds), or the patient experiences respiratory difficulties in the postoperative period is safe, cost-effective, and decreases the radiation exposure to patients.