Sonography After Thoracic Surgery - SATS (CT0011)

Following thoracic surgery (both open and thoracoscopic) patients have a surgically induced pneumothorax and hence tube thoracostomy is needed to drain the air and effusion. Due to this, patients must undergo post operative chest x-ray (CXR) evaluations in order to evaluate the chest and make decisions regarding removal of chest tubes as well as for decisions regarding patient discharge. Following chest tube removal, most surgeons advocate further CXR evaluation to assure that no pneumothorax was introduced during removal of the tube.

Repetitive CXR evaluations are costly, inconvenient, expose the patient and healthcare worker to repetitive radiation, and require time. Surgeon-performed US could be performed as an adjunct to physical examination. This would allow surgeons to make decisions regarding chest tube removal during rounds, alleviate the need for most CXRs as well as decrease patient length of stay. The goals of this project is to: evaluate the reliability and accuracy of surgeon-performed US following thoracic surgery, and evaluate the potential improved convenience for patients and the healthcare system using surgeon-performed US.

US technology has traditionally been the domain of the radiologist; however, recently US has evolved into an important tool for the clinician, similar to the stethoscope of the past, which can be utilized in an organ and specialty specific manner. Users of US in clinical care on a daily basis for specialty specific indications are: cardiologists, gastroenterologists, anesthesiologists, OBGYN, trauma, breast, ENT, hepatobiliary, and colorectal surgeons. US technology has yet to find its place in the domain of the thoracic surgeon and in the diagnosis and treatment of pulmonary malignancy, although there are many potential important applications for its use. We believe that portable hand-held ultrasound may be the thoracic surgeon's stethoscope of the future.

Thoracic ultrasound has been shown to be accurate at diagnosing pneumothorax (sensitivity, specificity = 90%) and has been well studied in the trauma population (sensitivity 95%) , however, few studies have been done using thoracic ultrasound in the non-injured population . To our knowledge, there are currently no centers using thoracic ultrasound routinely in the post-operative setting following general thoracic surgery.

Buzzas et al. showed that surgeons and surgical residents performing focused abdominal sonography for the initial evaluation of trauma patients were able to correctly diagnose injuries as safely and accurately as radiologists . Sensitivity, specificity, accuracy and negative predictive values were not significantly different between the surgeon and radiologist groups.