Routine Chest X-Ray Prior to Thyroid Surgery: Is It Always Necessary?
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Despite lack of evidence-based support, chest X-ray (CXR) prior to thyroid surgery is often used to identify tracheal deviation that may predict difficulty with intubation. The aim of this study is to establish the utility of preoperative CXR to assess tracheal deviation in this group of patients.
We analyzed a prospective database of 1,000 consecutive patients who underwent thyroid surgery. Patients’ charts were reviewed for demographic data, CXR readings, other imaging findings, anesthesia records, and pathology findings. Patients with tracheal deviation (TD) on CXR were compared to patients without (no TD).
Six hundred eighty-nine (69 %) patients had a CXR performed prior to surgery. TD was identified in 252 (37 %) patients while 437 (63 %) did not have TD. The two groups did not significantly differ in mean age, BMI, or gender. Patients with TD on CXR had larger thyroid glands (51 ± 4 vs. 28 ± 2 g, p < 0.001) and reported a higher rate of tracheal compressive symptoms (19 vs. 12 %, p = 0.005). However, this did not translate into more difficult intubations as reported by the anesthesiologist (5 vs. 7 %, p = 0.31) or more intubation attempts (1.2 ± 0 vs. 1.1 ± 0, p = 0.1). Lung findings on CXR that resulted in further workup were identified in 32 (5 %) patients, with additional pathology found in only 6 (1 %) patients.
There is no correlation between a finding of tracheal deviation on preoperative CXR and difficult intubation in thyroid patients. Therefore, CXR for the sole purpose of identifying tracheal deviation in thyroid surgery candidates is not warranted.
- Veldkamp WJ, Kroft LJ, Geleijns J (2009) Dose and perceived image quality in chest radiography. Eur J Radiol 72:209–217 CrossRef
- Sigurdson AJ, Bhatti P, Preston DL et al (2008) Routine diagnostic X-ray examinations and increased frequency of chromosome translocations among U.S. radiologic technologists. Cancer Res 68:8825–8831 CrossRef
- Mettler FA Jr, Thomadsen BR, Bhargavan M et al (2008) Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys 95:502–507 CrossRef
- Caplan RA, Posner KL, Ward RJ et al (1990) Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 72:828–833 CrossRef
- Joo HS, Wong J, Naik VN et al (2005) The value of screening preoperative chest X-rays: a systematic review. Can J Anaesth 52:568–574 CrossRef
- McHenry CR, Piotrowski JJ (1994) Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome. Am Surg 60:586–591
- McManus C, Luo J, Sippel R et al (2011) Should patients with symptomatic Hashimoto’s thyroiditis pursue surgery? J Surg Res 170:52–55 CrossRef
- Alfonso A, Christoudias G, Amaruddin Q et al (1981) Tracheal or esophageal compression due to benign thyroid disease. Am J Surg 142:350–354 CrossRef
- American Society of Anesthesiologists Task Force on Management of the Difficult Airway (1993) Practice guidelines for management of the difficult airway. Anesthesiology 78:597–602
- Randolph GW, Shin JJ, Grillo HC et al (2011) The surgical management of goiter: Part II. Surgical treatment and results. Laryngoscope 121:68–76 CrossRef
- Bouaggad A, Nejmi SE, Bouderka MA et al (2004) Prediction of difficult tracheal intubation in thyroid surgery. Anesth Analg 99:603–606 CrossRef
- Voyagis GS, Kyriakos KP (1997) The effect of goiter on endotracheal intubation. Anesth Analg 84:611–612
- Wakeling HG, Ody A, Ball A (1998) Large goitre causing difficult intubation and failure to intubate using the intubating laryngeal mask airway: lessons for next time. Br J Anaesth 81:979–981 CrossRef
- St Clair CM, Shah M, Diver EJ et al (2010) Adherence to evidence-based guidelines for preoperative testing in women undergoing gynecologic surgery. Obstet Gynecol 116:694–700 CrossRef
- Neragi-Miandoab S, Wayne M, Cioroiu M et al (2010) Preoperative evaluation and a risk assessment in patients undergoing abdominal surgery. Surg Today 40:108–113 CrossRef
- Pollard DB, Weber CW, Hudgins PA (2005) Preoperative imaging of thyroid goiter: how imaging technique can influence anatomic appearance and create a potential for inaccurate interpretation. AJNR Am J Neuroradiol 26:1215–1217
- Combes X, Le Roux B, Suen P et al (2004) Unanticipated difficult airway in anesthetized patients: prospective validation of a management algorithm. Anesthesiology 100:1146–1150 CrossRef
- Routine Chest X-Ray Prior to Thyroid Surgery: Is It Always Necessary?
World Journal of Surgery
Volume 36, Issue 11 , pp 2584-2589
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