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Utility of Recovery Room vs Post-Operative Day 1 Radiographs Following Shoulder Arthroplasty.

Taylor Den Hartog¹, Maria Bozoghlian¹, Garrett Christensen¹

¹Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

The Iowa Orthopaedic Journal

|June 26, 2024

Summary

Postoperative radiographs in the post-operative recovery unit (PACU) are lower quality and do not change patient management. Radiographs taken on post-operative Day 1 in the radiology suite offer superior quality for baseline assessment after shoulder arthroplasty.

Keywords:

post-anesthesia care unit (PACU)quality radiographs total shoulder arthroplasty

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Area of Science:

Orthopedic Surgery
Radiology
Medical Imaging

Background:

Postoperative radiographs after shoulder arthroplasty are taken at varying times.
Radiographs obtained in the post-operative recovery unit (PACU) are frequently of lower quality.
The impact of radiograph timing on patient management is not well understood.

Purpose of the Study:

To compare the quality of PACU radiographs versus those taken on post-operative Day 1 (POD1) in the radiology suite.
To evaluate the influence of radiograph quality on subsequent patient management decisions.

Main Methods:

A comparative study of 50 anatomic total shoulder arthroplasties (TSA) with PACU radiographs and 50 with POD1 radiology suite radiographs.
Radiographs were independently reviewed and graded for quality by three blinded authors.
Inter-rater and intra-rater reliability were assessed using weighted kappa statistics.

Main Results:

No significant differences in patient demographics (age, sex, BMI, comorbidities) between the two groups.
Moderate to substantial intra-observer (kappa: 0.58-0.67) and inter-observer (kappa: 0.605-0.66) reliability in radiograph assessment.
Significantly higher quality radiographs were obtained in the radiology suite (57%) compared to the PACU (30%) (p<0.001).

Conclusions:

Postoperative radiographs taken in the PACU are generally of inadequate quality.
PACU radiographs do not impact patient management decisions.
Radiographs obtained in the radiology suite on POD1 are of higher quality and serve as a better baseline.
Higher quality baseline radiographs are crucial for accurate post-operative assessment in shoulder arthroplasty.