The utility of routine postoperative chest radiography in the postanesthesia care unit

To evaluate the clinical significance and cost effectiveness of routine chest radiographs in the postanesthesia care unit (PACU).

Prospective study.

University hospital.

100 patients who were admitted to the PACU following various surgical procedures, and in whom a postoperative chest radiograph was routinely performed.

Chest radiograph was taken in each study patient soon after admission to the PACU. The indications for postoperative chest radiograph were: thoracotomy (30 patients), thoracoscopy (7), central vein catheterization (CVC) (75), pulmonary artery catheterization (3), and mechanical ventilation (36). A staff anesthesiologist examined each patient, evaluated each chest radiograph, and decided if a treatment action was to be taken. A chest radiologist later evaluated each chest radiograph, and her interpretation was compared with the anesthesiologist's interpretation to assess if this may affect patient management.

The anesthesiologist found eight abnormal chest radiographs (8%): three with pulmonary congestion, four in whom the CVC was in the right atrium, and one with malpositioned CVC. In four patients (4%), the chest radiographic findings directly affected patient management. The radiologist confirmed the anesthesiologist's interpretation and found four additional abnormalities: one pulmonary congestion, one malpositioned CVC, and two chest radiographs, each with a small pneumothorax.

Abnormal chest radiographic findings resulted in a change in the management of only 4% of the patients. Therefore, the yield of a routine postoperative chest radiograph in the PACU is low. Performing a chest radiograph for a specific indication rather than on a routine basis, may decrease work load and save expenses. Postoperative chest radiography can be safely evaluated by a staff anesthesiologist.