Is routine preoperative chest X-ray indicated in elderly patients undergoing elective surgery?

In our hospital pre-operative chest x-ray (CXR) are routinely requested without prior establishment of any medical indication for patients of 70 or more years of age who are undergoing elective surgery. The aim of this study was to determine if routine preoperative chest x-rays are justifiably indicated for elderly patients undergoing elective surgery in the University of Nigeria Teaching Hospital, Enugu.

One hundred and twenty consecutive patients aged 70 or more years were studied between January 2003 and December 2005. As part of our routine preoperative evaluation, detailed history and thorough physical examination were carried out with a view to eliciting symptoms and signs that would normally indicate chest X-ray. Pre-operative ECG were also examined for presence or absence of abnormalities that could indicate chest X-ray. Preoperative chest X-rays of the 120 patients were also studied and radiological findings noted.

Ninety (75%) out of 120 patients had medical indications for chest X-ray. The remaining 30 (25%) were considered to lack medical indication for chest X-ray. Overall, 105 out of the 120 (84%) patients had abnormal findings on chest X-ray.

Routine preoperative chest X-rays in the elderly patients are worthwhile even without medical indication.