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

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

DESIGN: Prospective study.

SETTING: University hospital.

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

INTERVENTIONS: 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.

MEASUREMENTS AND MAIN RESULTS: 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.

CONCLUSIONS: 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.