This is based on multiple studies that have shown minimal benefit from the routine use of chest radiography before surgery. Joo et al [17] conducted a systematic literature review to investigate the value of screening chest radiographs before surgery. They found that the diagnostic yield of preoperative chest radiographs in patients <50 years of age is low and are generally not recommended in patients <70 years of age. Most radiologic abnormalities found on preoperative imaging were chronic diseases and did not affect management or outcome [17]. A large retrospective study in 1983 found that preoperative chest radiographs in low-risk patients were unnecessary with only 0.3% of chest radiographs finding a relevant finding [6]; furthermore, these abnormalities were not associated with any perioperative complications or need for additional interventions. However, radiographic abnormalities were more common in patients with known risk factors based on clinical history and examination. The authors contended that clinical evaluation could appropriately predict which patients should undergo preoperative chest radiography and argued against the use of chest radiography for routine preoperative evaluation [6]. A meta-analysis by Archer et al [18] found that unsuspected radiologic findings on routine preoperative chest radiography were rare, occurring in only 1.3% of cases; these rare findings resulted in a change in management in only 0.1% of cases. Gagner et al [19] performed a retrospective review of 1,000 patients who underwent a preoperative chest radiograph and found that 7.4% of studies were abnormal. Abnormal chest radiographs were more common in older individuals than in younger individuals (30% of patients >50 years of age versus 3% in patients <50 years of age), and there were no changes in clinical outcomes due to chest radiographic findings.
Routine Chest Imaging. This is based on multiple studies that have shown minimal benefit from the routine use of chest radiography before surgery. Joo et al [17] conducted a systematic literature review to investigate the value of screening chest radiographs before surgery. They found that the diagnostic yield of preoperative chest radiographs in patients <50 years of age is low and are generally not recommended in patients <70 years of age. Most radiologic abnormalities found on preoperative imaging were chronic diseases and did not affect management or outcome [17]. A large retrospective study in 1983 found that preoperative chest radiographs in low-risk patients were unnecessary with only 0.3% of chest radiographs finding a relevant finding [6]; furthermore, these abnormalities were not associated with any perioperative complications or need for additional interventions. However, radiographic abnormalities were more common in patients with known risk factors based on clinical history and examination. The authors contended that clinical evaluation could appropriately predict which patients should undergo preoperative chest radiography and argued against the use of chest radiography for routine preoperative evaluation [6]. A meta-analysis by Archer et al [18] found that unsuspected radiologic findings on routine preoperative chest radiography were rare, occurring in only 1.3% of cases; these rare findings resulted in a change in management in only 0.1% of cases. Gagner et al [19] performed a retrospective review of 1,000 patients who underwent a preoperative chest radiograph and found that 7.4% of studies were abnormal. Abnormal chest radiographs were more common in older individuals than in younger individuals (30% of patients >50 years of age versus 3% in patients <50 years of age), and there were no changes in clinical outcomes due to chest radiographic findings.