Elimination of routine chest radiographs following off-pump coronary artery bypass surgery: A randomized controlled trial study


1 Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran

3 Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4 Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Background: Post cardiac surgery routine chest radiographs (CXRs), ordered without any clinical and laboratory indications, is a standard obligatory practice in many cardiothoracic centers. Routine CXRs incur cost, manpower, and radiation. The objective of this study is to assess early outcome in off-pump coronary artery bypass (OPCAB) patients with postoperative routine versus clinically indicated CXR protocols.
Materials and Methods: This study is a randomized clinical trial conducted on 231 OPCAB candidates in Afshar Cardiac Center, Yazd, Iran. Patients were categorized into two groups. All 118 patients in group A had routine postoperative CXRs. The 113 patients in group B were selectively exposed to CXR only on clinical indications. All patients were postoperatively followed up for 30 days. Data gathered from both groups were statistically analyzed.
Results: Routine postoperative CXRs obtained in 118 OPCAB group A candidates showed abnormal findings in 20 patients that did not require new intervention. One month follow-up of these patients showed no complications. In 113 OPCAB candidates of group B, 7 on-demand CXRs were obtained on clinical evaluation that required added intervention. In a 1-month follow-up of this group, five patients presented with symptomatic complaints. On re-examination, none needed readmission, intervention, or paraclinical evaluation. No complications were observed due to CXR elimination.
Conclusion: The study suggests that postoperative CXR selected on clinical grounds in place of routine CXR does not change early postoperative outcome of OPCAB procedure.


Shekar PS. On-pump and off-pump coronary artery bypass grafting. Circulation 2006;113:e51-2.  Back to cited text no. 1
Nwaejike N, Mansha M, Bonde P, Campalani G. Myocardial revascularization by off-pump coronary bypass surgery (OPCABG): A ten year review. Ulster Med J 2008;77:106-9.  Back to cited text no. 2
Wiener-Kronish JP. Postoperative pleural and pulmonary abnormalities in patients undergoing coronary artery bypass grafts. Chest 1992;102:1313-4.  Back to cited text no. 3
Rubenfield GD, Caldwell E, Granton J, Hudson LD, Matthay MA. Interobserver variability in applying a radiographic definition for ARDS. Chest 1999;116:1347-53.  Back to cited text no. 4
Labidi M, Baillot R, Dionne B, Lacasse Y, Maltais F, Boulet LP. Pleural effusions following cardiac surgery: Prevelance, risk factors, and clinical features. Chest 2009;136:1604-11.  Back to cited text no. 5
Roa PS, Abid Q, Khan KJ, Meikle RJ, Natarajan KM, Morritt GN, et al. Evaluation of routine postoperative chest X-rays in the management of cardiac surgical patient. Eur J Cardiothorac Surg 1997;12:724-9.  Back to cited text no. 6
Chahine-Malus N, Stewart T, Lapinsky SE, Marras T, Dancey D, Leung R, et al. Utility of routine chest radiographs in a medical-surgical intensive care unit: A quality assurance survey. Crit Care 2001;5:271-5.  Back to cited text no. 7
Chong JL, Pillai R, Fisher A, Grebenik C, Sinclair M, Westaby S. Cardiac surgery: Moving away from intensive care. Br Heart J 1992;68:430-3.  Back to cited text no. 8
Hornick PI, Harris P, Cousins C, Taylor KM, Keogh BE. Assessment of the value of the immediate postoperative chest radiograph after cardiac operation. Ann Thorac Surg 1995;59:1150-4.  Back to cited text no. 9
Stevens JJ, Booth JV, Little J, Gopinath S, Ghosh S, Kneeshaw JD, et al. The value of immediate postoperative chest radiography in adult cardiac surgery. Br J Anaesth 1995;A110:56.  Back to cited text no. 10
Silverstein DS, Livingston DH, Elcavage J, Kovar L, Kelly KM. The utility of routine chest radiography in the surgical intensive care unit. J Trauma 1993;35:643-6.  Back to cited text no. 11
O'Brien W, Karski J, Cheng D, Sandler A. Does the immediate postoperative chest x-ray help in the clinical management of patients following cardiac surgery. Can J Anaesth 1995;42:A3-76.  Back to cited text no. 12
Tolsma M, Rijpstra TA, Schultz MJ, Mulder PG, van der Meer NJ. Significant changes in the practice of chest radiography in Dutch intensive care units: A web-based survey. Ann Intensive Care 2014;4:10.  Back to cited text no. 13
Ganapathy A, Adhikari NK, Spiegelman J, Scales DC. Routine chest x-rays in intensive care units: A systemic review and meta-analysis. Crit Care 2012;16:R68.  Back to cited text no. 14
Ahangar AG, Dar AM, Mir IA, Bhat MA, Lone GN, Shah SH. Role of routine chest roentgenography in patients with open heart operation. J K Science 2003;5:104-6.  Back to cited text no. 15
Hauser GJ, Pollack MM, Sivit CJ, Taylor GA, Balas DI, Guion CJ. Routine chest radiographs in pediatric intensive care: A prospective study. Pediatrics 1989;83:465-70.  Back to cited text no. 16
Quasney MW, Goodman DM, Billow M, Chiu H, Easterling L, Frankel L, et al. Routine chest radiographs in pediatric intensive care units. Pediatrics 2001;107:241-8.  Back to cited text no. 17
Palesty JA, Amshel CE, Dudrick SJ. Routine chest radiographs following central venous recatheterization over a wire are not justified. Am J Surg 1998;176:618-21.  Back to cited text no. 18
Gray P, Sullivan G, Ostryzniuk P, McEwen TA, Rigby M, Roberts DE. Value of postprocedural chest radiographs in adult intensive care unit. Crit Care Med 1992;20:1513-8.  Back to cited text no. 19
Gladwin MT, Slonim A, Landucci DL, Gutierrez DC, Cunnion RE. Canulation of the internal jugular vein: Is postprocedural chest radiography always necessary? Crit Care Med 1999;27:1819-23.  Back to cited text no. 20
Hamid M, Khan MU, Bashour AC. Diagnostic value of chest x-ray and echocardiography for cardiac tamponade in post cardiac surgery patients. J Pak Med Assoc 2006;56:104-7.  Back to cited text no. 21
Fedulla AJ, Lerner RM, Gibson J, Shayne DS. Sonographic measurement of diaphragmatic motion after coronary artery bypass surgery. Chest 1992;102:1683-6.  Back to cited text no. 22