The role of the routine pre-operative chest X-ray in the elderly general surgical patient

Abstract

In an unselected group of 233 patients aged 65 years and over undergoing non-cardiopulmonary surgery, 57.5% had some abnormality on routine pre-operative chest X-ray and 40.3% had an abnormality which was regarded as clinically significant. Of all patients, 32'2% subsequently required a postoperative chest film for diagnostic purposes, and in these cases the pre-operative X-ray was invaluable as a baseline. During the study period there were ten occasions where the discovery of an abnormality on a routine pre-operative chest film directly affected the treatment plan. Pre-operative chest radiology proved ineffective as a method of predicting postoperative respiratory complications and was of only limited effectiveness in predicting postoperative cardiac morbidity. It is concluded that a routine pre-operative chest X-ray should be available in all elderly surgical patients (a) as a baseline measurement and (b) to exclude unsuspected disease. The prediction of postoperative cardiac and respiratory morbidity, however, is best achieved by non-radiological means. © 1982 The Fellowship of Postgraduate Medicine.