OBJECTIVE: To find out which patients about to undergo general or gastrointestinal operations could have the routine preoperative posteroanterior chest radiograph omitted. DESIGN: Prospective open multicentre study. SETTING: 8 Public hospitals, France. SUBJECTS: 3959 consecutive patients about to undergo operations for benign disease were divided into 4 groups depending on the number of risk factors for cardiopulmonary complications (coexisting bronchopulmonary or cardiac conditions, abnormal clinical cardiopulmonary findings): group 1 (n = 2092) had no risk factors, group 2 (n = 946) had 1, group 3 (n = 645) had 2, and group 4 (n = 276) had 3 risk factors or more. INTERVENTIONS: Routine posteroanterior chest radiographs. MAIN OUTCOME MEASURES: Whether the findings on the radiograph (read by the anaesthetist) led to modifications in the type of anaesthesia or operative technique, or both, and whether radiographs were helpful in the postoperative management. RESULTS: 912 (23%) of the radiographs showed some abnormality. Changes were made in anaesthetic or surgical policy in 22 (0.1%), 11 (0.3%), 8 (1%), and 4 (1%) of patients in groups 1-4, respectively. The preoperative films were of some help in the management of about half the patients who developed postoperative cardiopulmonary complications. CONCLUSIONS: Preoperative chest radiographs should be routine for patients about to undergo general and gastrointestinal operations with three or more risk factors, and done selectively for patients with one or two. Routine preoperative films are unnecessary for patients with no risk factors.
OBJECTIVE: To find out which patients about to undergo general or gastrointestinal operations could have the routine preoperative posteroanterior chest radiograph omitted. DESIGN: Prospective open multicentre study. SETTING: 8 Public hospitals, France. SUBJECTS: 3959 consecutive patients about to undergo operations for benign disease were divided into 4 groups depending on the number of risk factors for cardiopulmonary complications (coexisting bronchopulmonary or cardiac conditions, abnormal clinical cardiopulmonary findings): group 1 (n = 2092) had no risk factors, group 2 (n = 946) had 1, group 3 (n = 645) had 2, and group 4 (n = 276) had 3 risk factors or more. INTERVENTIONS: Routine posteroanterior chest radiographs. MAIN OUTCOME MEASURES: Whether the findings on the radiograph (read by the anaesthetist) led to modifications in the type of anaesthesia or operative technique, or both, and whether radiographs were helpful in the postoperative management. RESULTS: 912 (23%) of the radiographs showed some abnormality. Changes were made in anaesthetic or surgical policy in 22 (0.1%), 11 (0.3%), 8 (1%), and 4 (1%) of patients in groups 1-4, respectively. The preoperative films were of some help in the management of about half the patients who developed postoperative cardiopulmonary complications. CONCLUSIONS: Preoperative chest radiographs should be routine for patients about to undergo general and gastrointestinal operations with three or more risk factors, and done selectively for patients with one or two. Routine preoperative films are unnecessary for patients with no risk factors.
Authors: Marcovalerio Melis; Richard C Karl; Sandra L Wong; Murray F Brennan; Jeffrey B Matthews; Kevin K Roggin Journal: J Gastrointest Surg Date: 2010-03-06 Impact factor: 3.452