Postoperative Chest X-Rays After Open Reduction Internal Fixation of Clavicle Fractures May Not Be Cost-Effective or Necessary

Abstract

Objectives: To assess the use of chest x-rays after open-reduction internal fixation of clavicle fractures. Particularly in detection of acute postoperative pneumothorax and cost-effectiveness of obtaining routine chest x-rays postoperatively.

Design: A retrospective cohort study.

Setting: Level I trauma center.

Patients: Two hundred thirty-six patients who underwent ORIF from 2013 to 2020 between the ages of 12 and 93.

Intervention: Chest x-ray performed postoperatively.

Main outcome measurement: Presence of acute postoperative pneumothorax.

Results: Of the 236 patients who underwent surgery, 189 (80%) patients received a CXR postoperatively and 7 (3%) patients experienced respiratory symptoms. All patients who had respiratory symptoms received a postoperative CXR. Those who did not receive a CXR postoperatively did not experience any respiratory complications. Two patients in the cohort had a postoperative pneumothorax, which was present preoperatively and unchanged in size postoperatively. Both of these patients were managed with general anesthesia and endotracheal intubation for surgery. The most common finding on CXR postoperatively was atelectasis. The cost of a portable CXR can be upward of $594 when including technology, personnel fees, and radiologic interpretation.

Conclusion: Postoperative chest x-rays after clavicle open reduction and internal fixation did not detect any acute postoperative pneumothorax in asymptomatic patients. It is not cost-effective to routinely get chest x-rays in patients after open-reduction internal fixation of clavicle fractures. In our study, of the 189 chest x-rays performed, only 7 patients experienced postoperative respiratory symptoms. Our health care system as a total could have saved upward of $108,108 in total for these patients because they may have been considered nonreimbursable by an insurance provider.

Level of evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.