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Eur J Orthop Surg Traumatol. 2017 Oct;27(7):953-959. doi: 10.1007/s00590-017-1971-3. Epub 2017 May 11.

Preoperative chest radiographs in hip fracture patients: is there any additional value?

Author information

1
Department of Trauma Surgery, VU University Medical Centre, 7F029, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands. s.loggers@vumc.nl.
2
Department of Trauma Surgery, VU University Medical Centre, 7F029, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
3
Department of Emergency Medicine, VU University Medical Centre, Amsterdam, The Netherlands.
4
Department of Anesthesiology, VU University Medical Centre, Amsterdam, The Netherlands.
5
Department of Radiology, VU University Medical Centre, Amsterdam, The Netherlands.
6
Department of Medical Imaging, University of Toronto, Toronto, Canada.

Abstract

PURPOSE:

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.

METHOD:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

Additional value; Anesthesia; Cost-effectiveness; Geriatric; Hip fracture; Pre-assessment; Preoperative care; Preparative screening; Proximal femur fracture; Thoracic radiographs; Trauma surgery

PMID:
28497281
PMCID:
PMC5605580
DOI:
10.1007/s00590-017-1971-3
[Indexed for MEDLINE]
Free PMC Article

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