Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Vice Chair for Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Am Coll Radiol. 2021 Aug;18(8):1118-1127. doi: 10.1016/j.jacr.2021.03.015. Epub 2021 Apr 24.
To determine safety of shortened observation time without follow-up chest x-ray (CXR) after CT-guided transthoracic procedures (lung biopsy or fiducial placement) in patients without immediate postprocedural pneumothorax (PTX).
Consecutive patients that underwent CT-guided procedures between January 5, 2015, and June 19, 2017, were included in this retrospective institutional review board-approved HIPAA-compliant study. Data regarding postprocedural course, complications, and clinical follow-up of the patients were obtained through a review of electronic medical records. Descriptive statistics were used.
There were 441 procedures for 409 patients performed; 82 procedures were excluded because of predefined criteria. In 312 of 336 asymptomatic procedures (92.9%), asymptomatic patients did not undergo CXR after procedure, with 7 of 312 of these patients (2.2%) diagnosed with delayed PTX 2 to 10 days after the procedure. In 24 of 336 procedures (7.1%), asymptomatic patients underwent CXR within 4 hours with no PTX detected, and despite that 1 of 24 of these patients (4.2%) presented with delayed PTX 7 days after procedure. When no immediate postprocedural PTX was present, rate of observation PTX and delayed PTX was 1 of 359 (0.3%) and 8 of 359 (2.2%), respectively. Average duration of monitoring for outpatients (n = 295) was 2.0 hours with median of 1.8 hours. In 23 of 359 (6.4%) procedures, the patient became symptomatic during postprocedural observation with 1 of 23 (4%) developing PTX.
Obtaining routine postprocedural CXRs in asymptomatic patients without immediate postprocedural PTX after CT-guided transthoracic procedures is likely not necessary given the low likelihood of PTX.
确定在无即时术后气胸 (PTX) 的情况下，对 CT 引导下经胸程序（肺活检或基准点放置）后无随访胸部 X 光 (CXR) 的缩短观察时间的安全性。
回顾性纳入 2015 年 1 月 5 日至 2017 年 6 月 19 日期间接受 CT 引导程序的连续患者，本研究获得机构审查委员会批准并符合 HIPAA 规定。通过电子病历审查获取患者术后过程、并发症和临床随访的数据。使用描述性统计。
共进行了 409 例患者的 441 次手术；由于预定标准，82 例被排除在外。在 312 例无症状手术（92.9%）中，无症状患者在手术后未进行 CXR，其中 7 例（2.2%）在手术后 2 至 10 天被诊断为迟发性 PTX。在 336 例手术中的 24 例（7.1%）中，无症状患者在 4 小时内进行 CXR 且未发现 PTX，但其中 1 例（4.2%）在手术后 7 天出现迟发性 PTX。如果没有立即发生术后 PTX，观察性 PTX 和迟发性 PTX 的发生率分别为 1 例（359 例中的 0.3%）和 8 例（359 例中的 2.2%）。（n=295）门诊患者的监测平均持续时间为 2.0 小时，中位数为 1.8 小时。在 359 例手术中的 23 例（6.4%）中，患者在术后观察期间出现症状，其中 1 例（4%）发生 PTX。
在 CT 引导下经胸程序后，对于无即时术后 PTX 的无症状患者，常规进行术后 CXR 可能不必要，因为 PTX 的可能性较低。
