“Preop Chest X-rays and Exercise Stress Tests Reevaluated”

We are familiar with the usual requirement for a preoperative chest x-ray prior to every surgical procedure; but, is it really necessary? Surprisingly, the American College of Radiology (ACR) 2015 guidelines recommend against preoperative chest x-rays for average-risk patients. According to an ACR recommendation released as part of Choosing Wisely®, an ABIM Foundation campaign to identify uneconomical medical practices, only 2% of these x-rays initiate changes in treatment. Likewise, the American Society of Anesthesiologists (ASA) concluded in their 2002 guidelines that routine preoperative testing has little value in patient management during the surgical process. Even studies published by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) also support the position that chest x-rays should not be routinely administered before non-cardiac surgeries. However, routine chest x-rays are recommended by the American Heart Association for severely obese patients at risk for heart problems. Research shows that chest x-rays should also be done in patients over 60 or in those with potential heart or lung disease risk. This is because the chance of abnormal chest x-ray findings increases in older age. According to a 2015 JAMA Internal Medicine, use of chest x-rays is high: 92% of patients had preoperatively undergone one in the past quarter of the study period, adding to already exorbitant medical expenses.

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