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National Guideline Centre (UK). Preoperative Tests (Update): Routine Preoperative Tests for Elective Surgery. London: National Institute for Health and Care Excellence (NICE); 2016 Apr. (NICE Guideline, No. 45.)
8.1. Introduction
Chest X-rays (formally known as chest radiographs) can detect diseases of the lungs, pleura, heart, major vasculature, mediastinum, chest wall and diaphragm. In the preoperative setting, chest X-rays are used to assess known chronic medical conditions or to detect previously undiagnosed diseases. Conditions that are frequently detected in this setting include chronic obstructive pulmonary disease (COPD), heart failure, tuberculosis and lung cancers. However, chest X-rays involve exposure to a dose of radiation and are of questionable benefit in asymptomatic individuals, in whom the rate of abnormality detection is low. In addition, there is uncertainty concerning whether chest X-ray findings impact on perioperative management and whether rates of perioperative pulmonary complications are affected by the performance of a preoperative chest X-ray.
See section 4.4 for a summary of the methodological approach taken for this preoperative test.
8.2. Delphi survey results
As no new evidence on the use of chest X-ray as a routine preoperative test was identified during the scoping phase of this guideline, it was decided not to carry out an evidence review, but to include chest X-ray in the modified Delphi survey in order to re-evaluate the consensus held amongst health professionals on the value of routinely conducting the test before elective surgery.
The survey participants were asked if they would use chest X-ray as a routine preoperative test for patients undergoing elective surgery. As the consensus results clearly showed at the first round that chest X-ray was not used by over 70% of respondents, no further questions on the use of chest X-ray were asked in subsequent rounds of the survey. Please see Appendix L for full details on the survey method and results.
8.2.1. Delphi statements where consensus was reached
Table 48All surgery grades and comorbidities (cardiovascular, renal, respiratory, diabetes, obesity)
| Results % (round in which consensus was achieved) | |
|---|---|
| I do use chest X-ray tests for routine elective surgery | 23.20% |
| I do not use chest X-ray tests for routine elective surgery | 74.74% |
| I do not have the expertise to answer | 2.06% |
8.3. Economic evidence
Unit costs were provided for consideration alongside the Delphi survey results. Please see Appendix M for details. These are reported in Table 49 below.
Table 49
Unit cost of chest X-ray.
8.4. Recommendations and link to evidence
| Recommendations |
|
|---|---|
| Delphi | Delphi survey respondents strongly agreed that chest X-ray should not be used as a routine preoperative test in any population. The GDG agreed with the findings of the Delphi survey and considered that patient management would not be altered by chest X-ray results for any patient population considered within the guideline. The GDG noted the risk of ionising radiation associated with chest X-ray. This provided the GDG with further rationale to restrict the use of chest X-ray in routine preoperative testing. |
| Economic considerations | The cost of performing a chest X-ray was found to be £29.60, including staff time and equipment. The GDG did not feel that the results of a chest X-ray would often improve health outcomes as results were unlikely to influence any management strategies. The Delphi survey also showed a strong consensus against the use of chest X-rays, therefore supporting the notion that the test provides minimal clinical benefit. It is therefore unlikely that a chest X-ray is a cost-effective preoperative test. |
- Chest X-ray - Preoperative Tests (Update)Chest X-ray - Preoperative Tests (Update)
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