Are immediate postoperative X-rays of value in foot surgery patients?

A prospective nonrandomized study was conducted on consecutive patients undergoing foot surgery at a single academic medical center from April 1, 2022 through June 30, 2022. All patients underwent elective bone surgery, e.g. hallux abductovalgus surgery, lesser metatarsal osteotomy, midfoot procedures, hindfoot procedures. All patients obtained immediate x-rays in the post-anesthesia care unit per postoperative protocol at the medical center. A total of 56 patients were enrolled. The study was approved by the Institutional Review Board (IRB) of the medical center. The primary aim of the study was to determine if immediate postoperative x-rays altered the course of patient care in terms of unplanned return to the operating room, change in immobilization or a change in weightbearing recommendations. Eighteen (32 %) patients underwent hallux abductovalgus surgery, 10 (18 %) patients underwent lesser metatarsal surgery, 3 (5 %) underwent midfoot procedures, 10 (18 %) underwent hindfoot procedures and 15 (27 %) underwent other bone procedures. No patient required an early or unplanned return to the operating room based on the results of the immediate postop x-rays and 0 patients experienced a change in postoperative immobilization or weightbearing instructions. This relatively small prospective study suggests there is little value in obtaining immediate postoperative x-rays in the postanesthesia care unit as none resulted in immediate changes in postoperative management of patients. While immediate postoperative radiographs can be advantageous in specific clinical scenarios, the routine adoption of this practice should be carefully evaluated, considering added costs resulting in limited clinical benefits.