The Value of Interpretation of Intraoperative Fluoroscopy by Radiologists During Pediatric Fracture Treatment

Abstract

Orthopaedic surgeons frequently use intraoperative fluoroscopy to aid in the real-time decision-making process during fracture treatment. Radiologists routinely interpret and report on these fluoroscopic images. The goal of this combined retrospective and prospective study was to assess the value of this practice of having radiologists interpret intraoperative fluoroscopy for pediatric fracture treatment. In 500 consecutive pediatric patients who underwent fracture treatment in the operating room during a 1-year period, the following 4 parameters were retrospectively reviewed: (1) time between completion of procedure and availability of radiologist's report, (2) discrepancies between the surgeon-dictated operative report and the radiologist's report on the fluoroscopic images, (3) recommendations or unexpected findings in the radiologist's report, and (4) charges and reimbursement for the radiologist to report on the fluoroscopic images. In an additional 76 consecutive pediatric trauma patients, the number of intraoperative fluoroscopy images taken during fracture treatment and the number saved and sent to the radiologist were collected in a prospective and blinded manner. In 500 consecutive cases, 89% of radiologist reports were not available until after the end of the procedure. There was no discrepancy between the surgeon-dictated operative report on use of fluoroscopy and the radiologist's interpretation of the fluoroscopic images. Three (0.6%) patients had an unexpected finding on the radiologist's report but that did not change the fracture treatment. The mean charge by the radiologist was $166.96±11.84 and the mean reimbursement was $5.83±7.01. For the prospective arm of the study, 41.9% of all intraoperative fluoroscopy images taken were saved and sent to the radiologist. For the majority of procedures, the radiologist report was not available until after the end of the procedure. The radiologist's interpretation of intraoperative fluoroscopy did not alter fracture treatment in any patient. Because of limited benefit and low reimbursement, this study suggests that the practice of having a radiologist interpret intraoperative fluoroscopy during fracture treatment adds little value to patient care. Decision Analysis Level II.