The role of the routine pre-operative chest X-ray in the elderly general surgical patient

Abstract

SummaryIn an unselected group of 233 patients aged 65 years and over undergoing non-cardiopulmonary surgery, 57.5% had some abnormality on routine pre-operative chest X-ray and 40.3% had an abnormality which was regarded as clinically significant. Of all patients, 32'2% subsequently required a postoperative chest film for diagnostic purposes, and in these cases the pre-operative X-ray was invaluable as a baseline. During the study period there were ten occasions where the discovery of an abnormality on a routine pre-operative chest film directly affected the treatment plan. Pre-operative chest radiology proved ineffective as a method of predicting postoperative respiratory complications and was of only limited effectiveness in predicting postoperative cardiac morbidity.It is concluded that a routine pre-operative chest X-ray should be available in all elderly surgical patients (a) as a baseline measurement and (b) to exclude unsuspected disease. The prediction of postoperative cardiac and respiratory morbidity, however, is best achieved by non-radiological means.

Routine preoperative testing: a systematic review of the evidence.

“…A number of authors have asserted the importance of a preoperative chest X-ray in establishing a 'baseline' to assist in accurate interpretation of postoperative films if the patient develops postoperative cardiac or respiratory complications. 22,23 The example frequently given is that of postoperative pulmonary embolus, in which subtle chest X-ray features may not be apparent unless a preoperative film is available for comparison.…”

“…We identified 46 empirical studies which included preoperative chest X-ray, of which 28 reported data in a way that could be used in this review. 18,20,21,23,24, All of these were reports of simple case-series, with no comparison of testing policies between groups. Eleven studies were in adults, 18,20,21,23,33,[36][37][38]40,45,46 four of the studies were in children, 28,[30][31][32] four were in both adults and children, 27,41,44,47 and in the remainder of the studies the age of the study population was not specified.…”

“…18,20,21,23,24, All of these were reports of simple case-series, with no comparison of testing policies between groups. Eleven studies were in adults, 18,20,21,23,33,[36][37][38]40,45,46 four of the studies were in children, 28,[30][31][32] four were in both adults and children, 27,41,44,47 and in the remainder of the studies the age of the study population was not specified. 24,26,29,34,35,39,42,43,48 Of the 28 studies, all measured abnormality rates, 18 measured impact on clinical management, 18,20,21,27,28,[30][31][32]34,35,[37][38][39][40]42,…”

“…24,26,29,34,35,39,42,43,48 Of the 28 studies, all measured abnormality rates, 18 measured impact on clinical management, 18,20,21,27,28,[30][31][32]34,35,[37][38][39][40]42,45,47,48 and six measured the number of relevant adverse events (for example, respiratory complications) in patients with an abnormal test finding. 20,23,32,34,36,37 For only eight of the studies could routine tests be distinguished from indicated tests. 27,33,34,36,37,45,47,48 Details of the studies are summarised in Table 4.…”

Meningiomas in elderly patients. Clinico-therapeutic considerations

“…Recent studies [2,9] have, in fact, also shown that a recent infarction represents very considerable risk for the patient and, whenever possible, surgery should be postponed for at least 6 months. It would appear that preoperative chest-x-ray is of little help in predieting postoperative pulmonary complications: its utility lies in excluding other, unexpected, illness-es and in providing a standard for later comparison [23]. Another important problem is deep vein thrombosis and lung embolism that can be prevented by using, in selected cases, low doses of heparin as a postoperative precaution.…”