La radiographie thoracique préopératoire systématique en chirurgie générale est-elle utile ? Etude prospective multicentrique sur 3 959 malades

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In order to define which patients may not require a routine preoperative chest X-ray, a prospective multicenter study was carried out. It included 3 959 consecutive fifteen, or more, year-old patients, free from any cancer, scheduled for a general or gastrointestinal surgical procedure other than thoracotomy, and had a plain chest X-ray beforehand. This investigation was prescribed before surgery, either by the surgeon or the anaesthetist. Patients were classified according to selected risk factors : age, smoking, emergency surgery, a past history of lung, heart or vascular disease, abnormal clinical findings related to the cardiovascular and respiratory systems, and a previous chest film made less than one year before. There were 2 092 patients in Group I (no risk factors), 916 in group II (one risk factor), 645 in Group III (two risk factors), and 276 in group IV (three risk factors). Three endpoints were selected : a modification of operative schedule or anaesthetic technique, a change in surgical procedure, and the diagnosis of postoperative complications. A rate of 23.2 % of preoperative chest films were considered to be abnormal. This rate increased with age and the number of risk factors : 6.2 % in Group I and 72.5 % in Group IV. Surgical and anaesthetic procedures were modified as a result of the chest X-ray in only 0.5 % of patients : 0.1 % in Group I, 0.3 % in Group II, 1.2 % in Group III and 1.4 % in Group IV. When pulmonary or cardiac complications did occur after the surgery, the preoperative chest film was of no help for making this diagnosis in more than 50 % of cases. It may therefore be concluded that in general and gastrointestinal surgery not including cancer patients, a routine preoperative chest X-ray was unnecessary for patients without any risk factors (Group I). However, it must be carried out in patients with three risk factors (Group IV). In patients with only one or two risk factors (Groups II and III), this investigation should only be prescribed when justified by the clinical findings.