Objective
To establish the clinical necessity for mandatory chest X-ray following routine drain removal in paediatric cardiac surgical patients.

Methods
A retrospective analysis of all patients who underwent cardiac surgery between January and December 2008 in a tertiary referral paediatric cardiac surgical centre has been performed.
Exclusion criteria were:
a) premature patients undergoing closure of patent ductus arteriosus being immediately transferred back to the referring hospital
b) patients who died with chest drains still in situ
c) patients who underwent pacemaker procedures or wound revisions.
Three hundred forty-five patients underwent 360 operations.
Forty-two out of 345 (12%) patients fitted the exclusion criteria.
The costs associated with a routine chest X-ray at our institution are £ 27 pounds sterling.

Results
Three hundred and ninety chest drains were removed in 303 patients.
Nineteen patients (6.3%) required chest drain reinsertion: 4 because of pneumothorax (1.3%), and 15 (5.0%) because of pleural effusion.
Three out of the 4 patients with pneumothorax were symptomatic, and would have triggered a chest X-ray irrespectively.
Therefore a minimum of 299 chest X-rays could have been avoided, for the total cost of £ 8,073 pound sterling.

Conclusions
Routine X-rays after chest drain removal does not substantially add to the clinical management of patients. If this practice remains limited to the symptomatic patients, this approach could lead to a significant cost-saving.