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

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Journal of orthopaedic trauma


OBJECTIVES: To assess the utility of chest x-rays following open reduction internal fixation of clavicle fractures. Particularly in terms of detection of acute postoperative pneumothorax and cost- effectiveness of obtaining routine chest x-rays post-operatively.

DESIGN: A retrospective cohort study.

SETTING: Level I trauma centerPatients 236 patients who underwent ORIF from 2013 to 2020 between the ages of 12 and 93.

INTERVENTION: Chest x-ray performed post-operatively.

MAIN OUTCOME MEASUREMENT: Presence of acute postoperative pneumothorax.

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

CONCLUSION: Post-operative 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 following open reduction internal fixation of clavicle fractures. In our study, of the 189 chest x-rays performed, only seven patients experienced postoperative respiratory symptoms. Our healthcare system as a total could have saved upwards of $108,108 in total for these patients as they may have been considered non-reimbursable by an insurance provider.

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ePub ahead of print