Routine preoperative tests for elective surgery: summary of updated NICE guidance

Routine preoperative investigations are expensive, labour intensive, and of questionable value, especially as they may contribute to morbidity or cause additional delays due to spurious results.1 2 3 4 5 Preoperative assessment clinics are usually based in the hospital where surgery will occur and are run according to local policies and procedures. The number of elective surgeries within the NHS has risen: 10.6 million operations took place in 2012-13 compared with 6.61 million in 2002-03. Even if only a small percentage of tests are unnecessary, large numbers of patients will be affected.

Elective surgeries are those scheduled in advance and excludes medical emergencies. The guidance covers patients over 16 years old. It includes healthy people and those who have one or more of the following comorbidities—cardiovascular, respiratory, renal, diabetes, and obesity—who are having minor, intermediate, or major or complex elective surgery (box 1). Individuals are classified by the severity of disease using the American Society of Anesthesiologists (ASA) classification system (box 2), and extent of surgery to guide testing.