MATERIALS & METHODS
This systematic review follows the 2020 updated Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA)
guideline.8
Literature search
We conducted a systematic literature search of studies investigating the
effectiveness of routine chest X-rays after drain removal in patients
undergoing cardiothoracic surgery in Pubmed, Medline via Ovid, Cochrane
central register of control trials (CENTRAL) and ClinicalTrials.gov.
There was no limit on the publication year of the studies, and the last
search was performed on 17 April 2022. The keywords used in combination
with Boolean operators include “cardiac surgery”, “thoracic
surgery”, “cardiothoracic surgery”, “chest drain removal”, “chest
tube removal”, “chest X-ray” and “chest radiograph”. The references
of the included studies and relevant reviews are also manually screened
for identifying potentially eligible studies.
Inclusion and exclusion
criteria
Original research studies reporting the incidence of pneumothorax and
chest X-ray findings after the chest drain removal in both adult and
paediatric patients undergoing cardiac and thoracic surgery procedures
were included. The exclusion criteria included case reports, case
series, reviews and studies on chest X-rays after drain removal on the
trauma patients exclusively.
Study screening, data extraction and outcome
measures
Two authors (KPPH, KEH) independently reviewed the included studies and
performed data extraction. Disagreements between the authors were
resolved by consensus or by escalating to another author (MST). The
following set of data was extracted: (i) study characteristics including
study design, (ii) patient population characteristics, (iii) incidence
of pneumothorax after removal of drain, (iv) clinical signs and symptoms
following the removal of chest drain, and (v) re-intervention
(re-insertion) of chest drain. The primary outcome measure is the
incidence of pneumothorax, whereas, the secondary outcomes include the
need for re-intervention following the removal of the chest drain, and
signs and symptoms after chest drain removal.
Quality assessment
The quality of the included studies was independently assessed by two
authors (KPPH, KST) using the Methodological Index for Nonrandomized
Studies
(MINORS).9All included studies are moderate-quality studies with a global score
ranging from 8-12 out of 16.