The value of routine preoperative chest radiography prior to elective orthopaedic procedures requiring general anaesthesia

Abstract

Introduction Routine procedures are tests performed for asymptomatic, apparently healthy individuals, in the absence of any specific clinical indication, to identify conditions undetected by clinical history and examination. Locally, it has been routine practice to carry out chest radiography before surgical operations which require general anaesthesia, even though doubts have been expressed over the years in various studies, concerning the need for this examination preoperatively except when clinically indicated. Aim of the Study The aim of this study was to collect opinions of various anaesthetists to assess the value of routine preoperative CXRs, with particular attention to patients undergoing an elective orthopaedic procedure requiring general anaesthesia. Methodology Anaesthetists' opinion on preoperative chest radiography was collected by performing a crosssectional, non-experimental research design. Six anaesthetists working in an elective orthopaedic theatre in a local general hospital were interviewed to assess the value of twentynine preoperative chest radiographs of patients undergoing an elective orthopaedic procedure under general anaesthesia. Results Findings of this study revealed that preoperative chest radiography is not routinely indicated for all patients, but should be performed when indicated by clinical history and physical examination, as this test did not benefit asymptomatic patients in terms of detecting unsuspected abnormalities. The abnormalities detected were suspected from clinical examination, which however were not significant to anaesthesia. Also, none of the preoperative CXRs (whether normal or abnormal) had an influence on anaesthetic management. Moreover, anaesthetists would have still proceeded with anaesthesia for most of the preoperative CXRs that were considered 'justified', if the chest radiograph was not available. Conclusion Based on the findings of the study, the researcher has put forward a number of conclusions and recommendations which offer effective means of improving the preoperative chest radiography practice for the interest of patient's safety, to reduce radiation dose, whilst reducing the Medical Imaging Department's costs and workload of unjustified examinations.