Prospective assessment of a protocol for selective ordering of preoperative chest x-rays

Abstract

Routine preoperative chest x-rays are still widely employed worldwide, although results of many studies do not support their broad utilization. A protocol for selective ordering of preoperative chest x-rays, according to the patient's clinical status, medical history and scheduled surgery, was developed and implemented in a teaching hospital in Paris. The utilization of the protocol during a one-year period was evaluated. Eleven hundred and one chest x-rays were ordered in 3866 patients (28 per cent). Five hundred and sixty-eight x-rays (52 per cent) were abnormal. One hundred and sixty-six (15 per cent) were considered useful by the anaesthetists, who took into account the entire hospital course, although only 51 (5 per cent) had an impact on the surgical plan or anaesthetic management. Among the 2765 patients who did not have a preoperative chest x-ray, two patients could have benefited from the chest x-ray, in the view of anaesthetists. Chart review for these two patients and for patients who had perioperative complications in the absence of a preoperative chest x-ray revealed that no complications could be linked to the lack of preoperative chest x-ray ordering. This study shows that the abandonment of routine ordering of preoperative chest x-rays does not produce adverse effects on patient care.

Preoperative evaluation and a risk assessment in patients undergoing abdominal surgery

“…54 One scenario in which preoperative chest X-rays may be of value is in ruling out metastases in the patients with a known malignancy. 55 Currently, a preoperative chest X-ray is recommended only for patients with acute pulmonary abnormalities, questionable metastatic disease, patients with CHF, elderly patients, a long-standing history of smoking, and recent migrants from endemic countries. 56…”

Value of routine preoperative chest x-rays: a meta-analysis

“…Several reports have also considered whether the information obtained from routine preoperative radiographs have had or might have had, any influence on health outcomes. 15,[17][18][19]29 Since this test, when carded out on large numbers of patients, is associated with considerable costs and some health effects, it is important to establish the frequency with which new information of.clinical value is obtained, The present report describes a meta-analysis of published studies and was carried out with the object of estimating this frequency with greater confidence than could be derived from any individual report on its own. Unfortunate.ly, there is insufficient evidence on which to base estimates of how frequently information resulting from routine radiography influences health outcomes.…”

Impact of using a local protocol in preoperative testing: blind randomized clinical trial.

“…Charpak et al 16 , in an analysis of surgical patients who underwent a chest X-ray with a clinical indication identified that 52% had abnormalities in the examination, but in only 23% of the cases, these abnormalities were not expected by anamnesis and physical examination. Also in this study, the observed changes modified the anesthetic-surgical management in only 5% of the cases.…”