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While most effusions resolve spontaneously, a\u00a0subset progresses to cardiac tamponade requiring urgent intervention. This systematic review evaluated the true incidence of PPE and PPE-related reinterventions based on routine echocardiographic screening, and explored temporal evolution, symptomatology, and perioperative risk factors. A\u00a0comprehensive search of Embase, PubMed, and Web of Science through May 2025 identified 26\u00a0eligible studies including 8,495 patients. Data extraction followed PRISMA guidelines and quality assessment with the JBI checklist. Random-effects meta-analysis demonstrated a\u00a0pooled PPE incidence of 36% (95% confidence interval (CI) 25\u201349%), whereas only 3% (95% CI 2\u20134%) required reintervention, ranging from 2% after CABG to 6% after aortic surgery. Large effusions (&gt;\u202f2\u202fcm) were associated with a\u00a0substantially higher likelihood of intervention (54% [14\u201390%]), although spontaneous resolution remained common. Preventive strategies such as posterior pericardiotomy and posterior chest tube placement significantly reduced both PPE incidence and reintervention rates. Despite these findings, interpretation is limited by substantial heterogeneity in study design, definitions, and follow-up protocols. Standardized definitions, structured echocardiographic follow-up, and prospective studies are needed to improve risk stratification and guide clinical decision-making.<\/jats:p>","DOI":"10.1007\/s12471-026-02054-6","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T12:27:24Z","timestamp":1780662444000},"page":"254-264","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative pericardial effusion on routine echocardiography: A\u00a0review of incidence, progression, and management"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2212-6347","authenticated-orcid":false,"given":"Stefan","family":"van Dinter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurens","family":"Wollersheim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilson","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogier","family":"Donders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"van Royen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik-Jan","family":"Dieker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad","family":"Verhagen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"issue":"5","key":"2054_CR1","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/S0025-6196(11)62211-8","volume":"77","author":"TS Tsang","year":"2002","unstructured":"Tsang\u00a0TS, Enriquez-Sarano\u00a0M, Freeman\u00a0WK, et\u00a0al. 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