Pre-operative chest x-ray

For the treatment of

Assessing fitness of adult, elective surgical patients prior to routine surgery

Commissioning position

This intervention is commissioned if:

  • patients have not had a CT chest AND are planned to have:
    • cardiac or thoracic surgery OR
    • organ transplantation or live organ donation

OR

  • requested by the anaesthetist for those with:
    • suspected or established cardio-respiratory disease AND no chest radiograph in the previous 12 months AND who are likely to go to critical care after surgery OR
    • a recent history of chest trauma OR
    • acute respiratory symptoms OR
    • a significant smoking history AND no chest radiograph in the previous 12 months OR
    • malignancy and possible lung metastases OR
    • undergoing a major abdominal operation AND are at high risk of respiratory complications OR

recent immigration from countries where tuberculosis is still endemic AND no chest radiograph during the past 12 months.

Summary of rationale

NICE recommends that chest radiographs should not be routinely offered before elective surgery.

 

In the UK, most patients are seen up to 12 weeks before surgery in preoperative assessment clinics, where a structured history and examination is performed by a nurse. Relevant preoperative investigations may also be taken according to locally developed protocols.

 

Routine preoperative investigations are expensive, labour intensive, and of questionable value. Excessive pre-operative testing may cause anxiety for patients, delays in treatment due to spurious results, and further unnecessary investigation or treatment, without changing outcomes or influencing perioperative management of the patient. In addition, some investigations can be associated with increased patient morbidity, for example the small dose of ionising radiation (0.2mSv) that every patient is subjected to during a chest radiograph. A more structured approach is therefore required. In general, patients who are healthy or having relatively non-invasive surgery may require few, if any, pre-operative tests.

References

Pre-operative chest x-ray - EBI

NG45 Routine preoperative tests for elective surgery NICE

Associated Pathways

There are no associated pathways.

Specialties

Cardiology York Cardiology North Yorkshire Cardiology Hull Cardiology East Riding Cardiology North Lincolnshire Cardiology North East Lincolnshire Diagnostics York Diagnostics North Yorkshire Diagnostics Hull Diagnostics East Riding Diagnostics North Lincolnshire Diagnostics North East Lincolnshire Respiratory York Respiratory North Yorkshire Respiratory Hull Respiratory East Riding Respiratory North Lincolnshire Respiratory North East Lincolnshire

Places covered by

  • East Riding
  • Hull
  • North East Lincolnshire
  • North Lincolnshire
  • North Yorkshire
  • Vale of York
Date created: 03/12/2025, 16:25
Last modified: 04/12/2025, 10:08
Date due for review: 31/12/2028