Optimizing the Yield of Abnormal Preoperative Chest Radiographs in Elective Non-cardiothoracic Surgery: Development of a Risk Prediction Score and External Validation

Alisa Seangleulur; Ammarin Thakkinstian; Witchaya Supaopaspan; Amolchaya Kwankua; Warawut Sukkasem; Arpakorn Kunawudhi; Neranchala Soonthornkes; Palin Limpavitayaporn; Pokket Sirisreetreerux; Narongkorn Saiphoklang; John Attia; Gareth McKay; Sith Phongkitkarun; Chusak Okascharoen

doi:10.1007/s00268-023-07146-7

Optimizing the Yield of Abnormal Preoperative Chest Radiographs in Elective Non-cardiothoracic Surgery: Development of a Risk Prediction Score and External Validation

World J Surg. 2023 Nov;47(11):2698-2707. doi: 10.1007/s00268-023-07146-7. Epub 2023 Sep 6.

Authors

Affiliations

¹ Department for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
² Department of Anesthesiology, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand.
³ Department for Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
⁴ Department of Radiology, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand.
⁵ Department for Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
⁶ Department of Surgery, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand.
⁷ Department for Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand.
⁸ Department of Internal Medicine, Faculty of Medicine, Thammasat University, Khlong Luang, Pathum Thani, Thailand.
⁹ Center for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
¹⁰ Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Belfast, Northern Ireland.
¹¹ Department for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand. chusak.oka@mahidol.ac.th.

PMID: 37674044
DOI: 10.1007/s00268-023-07146-7

Abstract

Background: Guideline recommendations for preoperative chest radiographs vary to the extent that individual patient benefit is unclear. We developed and validated a prediction score for abnormal preoperative chest radiographs in adult patients undergoing elective non-cardiothoracic surgery.

Methods: Our prospective observational study recruited 703 adult patients who underwent elective non-cardiothoracic surgery at Ramathibodi Hospital. We developed a risk prediction score for abnormal preoperative chest radiographs with external validation using data from 411 patients recruited from Thammasat University Hospital. The discriminative performance was assessed by receiver operating curve analysis. In addition, we assessed the contribution of abnormal chest radiographs to perioperative management.

Results: Abnormal preoperative chest radiographs were found in 19.5% of the 703 patients. Age, pulmonary disease, cardiac disease, and diabetes were significant factors. The model showed good performance with a C-statistics of 0.739 (95% CI, 0.691-0.786). We classified patients into four groups based on risk scores. The posttest probabilities in the intermediate-, intermediate-high-, and high-risk groups were 33.2%, 59.8%, and 75.7%, respectively. The model fitted well with the external validation data with a C statistic of 0.731 (95% CI, 0.674-0.789). One (0.4%) abnormal chest radiograph from the low-risk group and three (2.4%) abnormal chest radiographs from the intermediate-to-high-risk group had a major impact on perioperative management.

Conclusions: Four predictors including age, pulmonary disease, cardiac disease, and diabetes were associated with abnormal preoperative chest radiographs. Our risk score demonstrated good performance and may help identify patients at higher risk of chest abnormalities.