Evaluating Abnormalities and Related Factors of Preoperative Chest X-Rays in Patients Undergoing Gastrointestinal Endoscopy

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Natcharee Ongkanchana


Background and objective: Preoperative Chest X-rays
(CXR) prior to intervention may be unnecessary among
patients with unremarkable history and physical
examination. Currently, there is no institutional guideline
of preoperative CXR for ambulatory procedure. This study
was designed to determine the proportion of abnormal
preoperative CXR in patients underwent gastrointestinal
endoscopy. Other objectives were to identify factors
associated with abnormalities and to describe the
intraprocedural complications.
Materials and Methods: The retrospective study was
conducted on adult patients underwent ambulatory
gastrointestinal endoscopy under sedation. The
abnormalities of pre-procedural CXR were classified into
cardiomegaly, active and inactive pulmonary infiltration,
lung nodule and bone abnormalities.
Results: Data of 580 patients were reviewed. The
proportion of abnormal CXR was 52.1%, predominantly
reported as cardiomegaly. The factors associated with
abnormalities were age (Adjusted OR 95% ,70.1 CI 1.05-
1.09), p< 0.001), American Society of Anesthesiologists
(ASA) classification II and III (Adjusted OR 1.68, 95%,

CI 1.09-2.59, p< 0.05) and Adjusted OR 6.40, 95%
CI 3.03-13.55, p< 0.001, respectively) The optimum cut-off
points of age, determined from the area under ROC curve
0.74 (95% CI 0.70-0.78), was ≥ 55 years old with 80.86%
sensitivity and 46.57% specificity. Intra-procedural
complications were 14.4% (hypotension (12.9%),
desaturation (0.5%), bradycardia, (0.7%) and hypertension
Conclusion: The proportion of abnormal preoperative
CXR was high and consistent with co-existing diseases
and aging. The age above 55 years might be an indicator
to detect CXR abnormalities among ambulatory patients.
Nevertheless, history taking and physical examination
were attributable for obtaining CXR while the procedure
under sedation by certified anesthesia personnel
demonstrated low rate of cardiorespiratory adverse events.

Article Details

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