- The request for pre-operative investigations should be based on:
- Factors apparent from the clinical assessment
- The likelihood of asymptomatic abnormalities
- The severity of the surgery contemplated
Indications for preoperative investigations
| Investigation |
Indication |
| Full blood count |
All adult women |
|
Men over the age of 60 years |
|
Cardiovascular or haematological disease |
| Urea & electrolytes |
All patients over 60 years |
|
Cardiovascular and renal disease |
|
Diabetics |
|
Patients on steroids, diuretics, ACE inhibitors |
| ECG |
Men over 40 years |
|
Women over 50 years |
|
Cardiovascular disease |
|
Diabetics |
| Chest X-ray |
Cardiovascular and respiratory disease |
|
Malignancy |
|
Major thoracic and upper abdominal surgery |
- Pre-operative investigations rarely uncover unsuspected medical
conditions
- Inefficient as a means of screening for asymptomatic disease
- 5% of patients have abnormalities on investigations not predicted by a
clinical assessment
- 0.1% of these investigations ever change the patients management
- 70% of pre-operative investigations could be eliminated without
adverse effect
NICE Guidelines
- The National Institute for Clinical Excellence has produced guidelines
on preoperative tests
- These tests include
- Chest x-ray
- ECG
- Full blood count
- Clotting screen
- Renal function
- Random blood glucose
- Urinalysis
- Blood gases
- Lung function tests
- Recommendations are graded
- Red - not required
- Amber - test to considered
- Green - recommended
- Recommendations are based on
- Age
- ASA Grade of patient
- Grade of surgery
NICE Guidelines
(2003) on Preoperative Tests
Bibliography
Barnard N A, Williams R W, Spencer E M. Preoperative patient
assessment: a review of the literature and recommendations. Ann R Coll
Surg Eng 1994; 76: 293-297. |