Usefulness of routine preoperative chest roentgenograms in elderly patients.

One hundred thirty-six charts of preoperative patients over the age of 59 years were reviewed to determine whether clinical criteria alone are sufficient to identify patients who would not benefit from preoperative chest roentgenograms. Thirty-four percent of the patients without risk factors and 62% of those in the high-risk group were found to have significant abnormalities on chest roentgenograms (P less than 0.05). Postoperative complications occurred in 20% of patients in the high-risk group compared to 11% complication-rate in patients without clinical risk factors. The difference is not statistically significant. The prevalence of abnormal preoperative chest roentgenograms among those over the age of 70 years (49%) was not significantly different from the prevalence in those between the ages of 60 and 70 years (59%); however, the incidence of major postoperative complications was significantly higher in the older group (17 v 4%, P less than 0.01). Because of the substantial prevalence of abnormal chest roentgenograms and postoperative complications, it is concluded that in the elderly preoperative patients, in particular those over the age of 70 years, chest roentgenograms should be done on all patients regardless of clinical history.