VALUE OF ROUTINE PREOPERATIVE CHEST X-RAYS - A METAANALYSIS

The purpose of this study was to estimate the frequency with which rou tine postoperative chest x-rays lead to clinically relevant new inform ation. All articles in English, French and Spanish relating to routine chest radiography in North American or European populations were revi ewed, using the Medline database and references listed in reviews and periodicals published from 1966 to 1992, inclusive. Twenty-one reports which supplied sufficient information were included for meta-analysis . On average, abnormalities were found in 10% of routine preoperative chest films. In only 1.3% of films were the abnormalities unexpected, i. e., were not already known or would not otherwise have been detecte d (95% CI: 0 to 2 8%). These findings were of sufficient importance to cause modification of management in only 0.1% (95% CI: 0 to 0.6%). Th e frequency with which the new information influenced health could not be estimated Assuming only the direct cost to the health care system of each radiograph ($23), each finding which influenced management in any way would cost $23,000. It is concluded that in North American or European populations when a reliable history and a clinical examinatio n are carried out, the cost of this test is so high in relation to the clinical information provided that it is no longer justifiable.