Routine postoperative radiographs after tibia plateau fixation have minimal impact on patient care

Area of Science:

• Orthopedic Surgery
• Radiology
• Health Economics

Background:

• Postoperative radiographs are standard in orthopedic surgery for assessing healing and complications.
• Current practice often includes obtaining images in the post-anesthesia care unit (PACU).
• The clinical utility and cost-effectiveness of PACU radiographs following tibial plateau ORIF remain under-evaluated.

Purpose of the Study:

• To evaluate the clinical utility of PACU postoperative radiographs.
• To assess the cost-effectiveness of PACU postoperative radiographs.
• To determine if PACU radiographs following tibial plateau ORIF impact patient management.

Main Methods:

• Retrospective review of 211 patients undergoing tibial plateau ORIF over 5 years.
• Analysis of PACU radiograph use and correlation with clinical notes for management changes.
• Calculation of radiograph costs using CPT codes.

Main Results:

• 67.3% of patients received PACU radiographs; 88.7% showed normal findings.
• Only 0.7% of patients had a management change due to PACU imaging (incidental foot fracture).
• Average cost per PACU radiograph was $433.55, totaling $91,480 over 5 years for 142 patients.

Conclusions:

• Routine PACU radiographs following tibial plateau ORIF offer minimal clinical utility and management change.
• The substantial cost associated with these radiographs outweighs their limited benefit.
• Discontinue routine PACU imaging unless intraoperative complications are suspected, thereby reducing costs and unnecessary procedures.