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Value of routine preoperative chest x-rays: a meta-analysis
C Archer1, A R Levy, M McGregor
1Conseil d'évaluation des technologies de la santé du Québec, Montreal.
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 1, 1993
Summary
Routine postoperative chest X-rays rarely provide new, clinically relevant information. The high cost of these imaging tests outweighs the limited benefits, making them unjustifiable in many patient cases.
Area of Science:
- Medical Imaging
- Radiology
- Health Economics
Background:
- Routine postoperative chest radiography is a common practice.
- The clinical utility and cost-effectiveness of this diagnostic tool remain debated.
Purpose of the Study:
- To estimate the frequency of clinically relevant new information from routine postoperative chest X-rays.
- To assess the cost-benefit ratio of routine chest radiography in clinical decision-making.
Main Methods:
- Systematic review and meta-analysis of studies published between 1966 and 1992.
- Inclusion of English, French, and Spanish articles on routine chest radiography in North American and European populations.
- Analysis of 21 reports providing sufficient data for meta-analysis.
Main Results:
- Abnormalities detected in 10% of routine preoperative chest films.
- Unexpected abnormalities, not previously known or otherwise detectable, occurred in only 1.3% of films.
- Management modification due to new findings occurred in a mere 0.1% of cases, with an estimated cost of $23,000 per influenced management.
Conclusions:
- Routine postoperative chest X-rays yield minimal clinically relevant new information in populations with reliable history and clinical examination.
- The high cost associated with routine chest radiography is not justified by the limited diagnostic yield.
- Re-evaluation of the necessity of routine postoperative chest imaging is recommended based on cost-effectiveness.