The Use of Chest Radiography in Preoperative Assessment for Cardiac Surgery

Abstract

Purpose: Traditionally, chest radiographs were used to provide information about the heart size, pulmonary vasculature and the lungs. Current guidelines still recommend all patients undergoing cardiac surgery have a preoperative chest X-ray (CXR). With most patients going for cardiac surgery, the use of ECHO, cardiac angiography and pulmonary functions test adequately address those aspects of the preoperative work up. The aim of this study is to assess whether the preoperative CXR provides a change to patient care. Methodology: A retrospective review of all patients undergoing cardiac surgery from Jan 2014-Dec 2014, allowing for at least 1 year follow-up. Emergency cases that did not receive pull work-up were excluded. Results: 262 patients underwent an elective or an urgent in-patient cardiac procedure that allowed for full preoperative workup. 7 patients out of 262 had a pulmonary irregularity noted on CXR, of which 5 progressed to have a CT chest. Only 1 patient had a pulmonary nodule excised at the time of surgery which proved to be benign, otherwise no change in management was seen in this group. All patients had pulmonary function tests which were acceptable to the operating surgeon and the anaesthetist. No patient has subsequently been diagnosed with lung cancer. Conclusion: The use of CXR for preoperative assessment is outdated and provides little useful additive information needed for cardiac surgery. Only patients with clear indications should be referred for radiography which would lead to improving cardiac unit expenditure, patient time and radiation exposure.