Anästhesie (C) – Patient-oriented utility of chest radiographs in preoperative evaluation

Goal of the Study:

Chest radiography is regularly performed in preoperative evaluation for elective surgical procedures. This practice seems to be contrary to the findings of studies published over decades that have found limited use in preoperative chest radiographs [1], as they seem to add little benefit to clinical decision making [2]. This study therefore seeks to evaluate the rate of changes to the perioperative process preoperative chest radiography conveys.

Methods:

Retrospective study using data from the preoperative evaluation database at the University Medical Centre Graz. Patients evaluated for non-emergency, non-cardiothoracic surgery between January 1^st, 2000 and December 31^th, 2016 were included. Patients in whom advanced thoracic imaging (computer tomography or magnetic resonance imaging) were already available were excluded.

Datasets were analysed automatically and manually by to researchers independently. Availability of chest radiographs was derived from respective data fields in the database. The patient-oriented utility was assessed based on the following parameters: whether the patient was cleared for surgery right away or delayed; whether additional investigations or consultations were required; whether specific interventions for preoperative optimisation were required. Pathologic findings that did not change the perioperative process were not considered relevant.

Results and Discussion:

223,554 documented pre-operative evaluations were extracted from the database. 10,275 were performed for cardiothoracic procedures and in 1,068 patients, recent chest imaging (either by CT or MRI) was already available; these patients were therefore excluded from the study.

In the resulting cohort of 212,210 patients, preoperative chest radiographs were available in 131,224 (62%) cases and were requested by the evaluating anaesthetist in a further 24,058 (11%) cases. These chest radiographs influenced the further course of perioperative management in only 222 (0.002%) cases.

Conclusion:

Preoperative chest radiographs rarely ever change the perioperative process in non-emergency, non-cardiothoracic surgery. Their utility in preoperative evaluation for these cases is limited at best.

References:

[1] Seymour DG, Pringle R, Shaw JW. The role of the routine pre-operative chest X-ray in the elderly general surgical patient. Postgrad Med J. 1982;58(686):741 – 745

[2] Kovacevic M, Goranovic T, Markic A et al. Usefulness of routine chest X-ray in preoperative evaluation of patients undergoing non-cardiopulmonary surgery: a prospective observational study. Eur J Anaest. 2012;29:16