When should we order preoperative chest radiography: A systematic review and clinical practice guidelines.

ABSTRACT

Routine preoperative investigation consumes much resource while Thailand suffers severe financial crisis. Objectives of the study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative chest radiography (CXR). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and search from studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review, there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative investigations yielded few positive results and were not very useful for patient care. From this review and the consensus, we proposed the guidelines, which consisted of a history questionnaire, physical examination and indication for investigation. For the preoperative CXR the indications were age > 45 years, history of cardiovascular and respiratory diseases, autoimmune deficiency syndrome (AIDS), heavy smoking, chronic cough or fever, malignancy and findings of abnormal breath sounds on examination. This study recommends and prefers preoperative CXR as indicated by history and physical examination to routine.