Preoperative chest radiographs in hip fracture patients: is there any additional value?
Tóm tắt
Preoperative screening in hip fracture patients is vital to minimize perioperative complications. Preoperative chest radiographs (POCR) are performed in many hip fracture patients. Earlier research showed that few POCR abnormalities influence perioperative policy. However, no studies in nonelective patient with a specific surgical conditions have been performed. With many hip fractures per year worldwide, a significant cost reduction could be made by performing selective POCR without compromising the quality of care. This study assessed the need for POCR in hip fracture patients. Retrospective analysis of low-energy trauma patients was performed aged 18 years and older in the VU University Medical Center for a hip fracture in a 5-year period. All preoperative diagnostics were analyzed. All adjourned operations were evaluated. A total of 642 patients were included, 70% female, matching current epidemiologic figures. The POCR showed abnormalities in 22.6%. In 0.6% the POCR lead to an adjournment of the operation (2.8% of abnormal POCR’s). These patients suffered from pneumonia. The POCR in these cases acted as a confirmation of the clinical diagnosis. Many factors involving the treatment of hip fracture patients are of importance in minimizing the risk of complications and mortality during and after admission. In 0.6% of all performed POCR’s an abnormality leads to the adjournment of the operation. In all four cases the POCR matched the clinical findings. Because the additional value of the POCR in hip fracture patients was limited, we think that its selective use in clinical abnormalities is safe and will reduce unnecessary costs.
Tài liệu tham khảo
Abrahamsen B, van Staa T, Ariely R et al (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650
Sheikh HQ (2017) A comprehensive analysis of the causes and predictors of 30-day mortality following hip fracture surgery. Clin Orthop Surg 9(1):10–18
Hu F (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43(6):676–685
Garcia-Miguel FJ, Serrano-Aguilar PG, López-Bastida J (2003) Preoperative assessment. Lancet 362:1749–1757
Joo HS, Wong J, Naik VN, Savoldelli GL (2005) The value of screening preoperative chest x-rays: a systematic review. Can J Anesth 52:568–574
Silvestri L, Gullo A (2004) Preoperative chest radiograph. The challenge continues. Minerva Anestesiol 70(6):437–442
Rucker L, Frye EB, Staten MA (1983) Usefulness of screening chest roentgenograms in preoperative patients. JAMA 250:3209–3211
Boghosian SG, Mooradian A (1987) Usefulness of routine preoperative chest roentgenograms in elderly patients. J Am Geriatr Soc 35:142–146
Lammers RJS, van Engelshoven JMA, Phaff A (1989) Nogmaals, de routinematige preoperatieve thoraxfoto. Ned Tijdschr Geneeskd 133:2288–2291
De Hert Stefan, Imberger Georgina, Carlisle John, Diemunsch Pierre, Fritsch Gerhard, Moppett Iain, Solca Maurizio, Staender Sven, Wappler Frank, Smith Andrew, the Task Force on Preoperative Evaluation of the Adult Noncardiac Surgery Patient of the European Society of Anaesthesiology (2011) Preoperative evaluation of the adult patient undergoing non-cardiac surgery: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 28:684–722
The Association of Anaesthetists of Great Britain and Ireland (2010) AAGBI safety guideline; pre-operative assessment and patient preparation. Retrieved from https://www.aagbi.org/
Lanting LC, Stam C, den Hertog PC, Brugmans MJP (2006) Hoe vaak komen heupfracturen voor en hoeveel mensen sterven eraan?. Volksgezondheid Toekomst Verkenning, Nationaal Kompas, Volksgezondheid, RIVM, Bilthoven
Lewis PM (2016) When is the ideal time to operate on a patient with a fracture of the hip? A review of available literature. Bone Joint J 98(12):1573–1581
Saied NN (2017) Effect of anaesthesia type on postoperative mortality and morbidities. BJA 118(1):105–111
Neuman MD (2012) Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 117:72–92