Introduction: Guidelines from the British Orthopaedic Association and the British Geriatrics Society—‘The Blue Book’—recommend a pre-operative chest X-ray (CXR) in all patients with a fractured neck of femur (NOF), except in younger, fitter individuals. At our hospital, initial audit of this standard found 33% of patients meeting the criteria received a pre-operative CXR. However, waiting for CXRs can delay the operation, thus indirectly affecting mortality. This survey was conducted to assess any detrimental effects in those with fractured NOF not receiving a pre-operative CXR.
Sampling methods: Data were collected retrospectively from the National Hip Fracture database and computerised notes of those admitted to the Norfolk and Norwich University Hospital with a NOF fracture that underwent surgery over 2 months.
Results: One hundred and thirty-five patients were included with no significant difference in the average age between those who had a pre-operative CXR (pre-op CXR group) and those who did not (83.9 versus 82.1 years). On average the pre-op CXR group had significantly more co-morbidities (2.02 versus 1.48; P < 0.02) and a significantly greater average time (in h) from admission to surgery (35.7 versus 23.7; P < 0.008).
The group without a pre-operative CXR had lower mortality rates at 15 days (2 versus 11%; P = 0.04) and lower rates of re-admission with pneumonia within 30 days (1 versus 14%; P = 0.007). However, there was no significant difference in average length of inpatient stay or rates of post-operative pneumonia.
Conclusions: Pre-operative CXRs are mostly performed on patients with more co-morbidity at admission, and who prove to have poorer clinical outcomes. The results suggest that clinical assessment at admission is sufficient for deciding who should have a pre-operative CXR. If CXRs are not necessary for all, adverse outcomes due to delays in operation while awaiting a pre-operative CXR can be minimised.