Routine Immediate Postoperative Chest Radiography After Minimally Invasive Pulmonary Lobectomy Has a Low…

Cohort studyTomography (Ann Arbor, Mich.)· Sep 2026

Routine Immediate Postoperative Chest Radiography After Minimally Invasive Pulmonary Lobectomy Has a Low Impact on Clinical Management: A Value-Based Imaging Analysis.

Nicola Rotolo, Andrea Imperatori, Alberto Colombo … Federico Fontana

Surgical Outcomes & RecoveryCohort studyQ2IF 2.6

Routine postoperative chest radiography after video-assisted thoracoscopic lobectomy rarely led to a change in management.

Routine Immediate Postoperative Chest Radiography After Minimally Invasive Pulmonary Lobectomy Has a Low Impact on Clinical Management: A Value-Based Imaging Analysis.

Nicola Rotolo … Federico Fontana

Tomography (Ann Arbor, Mich.) · Sep 2026

Background

Despite the widespread adoption of minimally invasive video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery) for pulmonary lobectomy and Enhanced Recovery After Surgery (Enhanced Recovery After Surgery) protocols, routine chest X-rays (chest X-rays) in the Post-Anesthesia Care Unit (Post-Anesthesia Care Unit) after video-assisted thoracoscopic surgery pulmonary lobectomy remain common.

Purpose

This study aimed to evaluate the therapeutic yield of routine Post-Anesthesia Care Unit chest X-rays following video-assisted thoracoscopic surgery lobectomy, in a homogeneous cohort (Post-Anesthesia Care Unit time point).

Methods

This single-center retrospective cohort study included 554 consecutive patients who underwent elective video-assisted thoracoscopic surgery lobectomy (2014-2025).

n = 5 patients

Results

of routine recovery-room chest X-rays changed management, so very few were useful

2.2%

Routine PACU CXR

16.8%

Post-drain-removal CXR

More results

By contrast, 93 post-drain-removal chest X-rays (16.8%; 95% CI: 13.7-20.0) led to a change ( p < 0.001).

The most frequent abnormal findings were pneumothorax (5.8%), atelectasis (4.5%), and pleural effusion (2.0%).

Routine Post-Anesthesia Care Unit imaging generated an estimated cost of €16.620 and a cumulative radiation exposure of 27.7 mSv.

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Conclusion · 1 of 2

Routine Post-Anesthesia Care Unit chest X-rays after video-assisted thoracoscopic surgery lobectomy has a very low therapeutic yield and rarely changes management in asymptomatic patients.

Conclusion · 2 of 2

These findings support a selective, symptom-driven imaging strategy, although further prospective studies are needed to confirm safety and effectiveness.

Routine Immediate Postoperative Chest Radiography After Minimally Invasive Pulmonary Lobectomy Has a Low Impact on Clinical Management: A Value-Based Imaging Analysis.

Routine Immediate Postoperative Chest Radiography After Minimally Invasive Pulmonary Lobectomy Has a Low Impact on Clinical Management: A Value-Based Imaging Analysis.

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