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Are routine preoperative chest radiographs useful in general surgery? A prospective, multicentre study in 3959 patients. Association des Chirurgiens de l'Assistance Publique pour les Evaluations médicales.

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.