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NICE - suggested preoperative tests based on complexity of surgery and ASA classification

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Suggested Investigations based on complexity of surgery and ASA classification.

ASA Classification used in this guide:

ASA 1

A normal healthy patient

ASA 2

A patient with mild systemic disease

ASA 3

A patient with severe systemic disease

ASA 4

A patient with severe systemic disease that is a constant threat to life

If Minor Surgery:

ASA 1

ASA2

ASA3 or ASA4

Full blood count

Not routinely

Not routinely

Not routinely

Haemostasis

Not routinely

Not routinely

Not routinely

Kidney Function

Not routinely

Not routinely

Consider in people at risk of AKI

ECG

Not routinely

Not routinely

Consider if no ECG results available from past 12 months

Lung function/arterial blood gas

Not routinely

Not routinely

Not routinely

If Intermediate Surgery:

 

ASA 1

ASA2

ASA3 or ASA4

Full blood count

Not routinely

Not routinely

Consider for people with cardiovascular or renal disease if any symptoms not recently investigated

Haemostasis

Not routinely

Not routinely

Consider in people with chronic liver disease

  • if people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance
  • if clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing

Kidney Function

Not routinely

Consider in people at risk of AKI

Yes

ECG

Not routinely

Consider for people with cardiovascular, renal or diabetes comorbidities

Yes

Lung function/arterial blood gas

Not routinely

Not routinely

Consider seeking advice from a senior anaesthetist as soon as possible after assessment for people who are ASA grade 3 or 4 due to known or suspected respiratory disease

 

If Major/Complex Surgery:

ASA 1

ASA2

ASA3 or ASA4

Full blood count

Yes

Yes

Yes

Haemostasis

Not routinely

Not routinely

Consider in people with chronic liver disease

  • if people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance
  • if clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing

Kidney Function

Consider in people at risk of AKI

Yes

Yes

ECG

Consider for people aged over 65 if no ECG results available from past 12 months

Yes

Yes

Lung function/arterial blood gas

Not Routinely

Not Routinely

Consider seeking advice from a senior anaesthetist as soon as possible after assessment for people who are ASA grade 3 or 4 due to known or suspected respiratory disease

Notes:

Surgery Grades

Examples

Minor

  • excising skin lesion
  • draining breast abscess

 

Intermediate

  • primary repair of inguinal hernia
  • excising varicose veins in the leg
  • tonsillectomy or adenotonsillectomy
  • knee arthroscopy

Major or Complex

  • total abdominal hysterectomy
  • endoscopic resection of prostate
  • lumbar discectomy
  • thyroidectomy
  • total joint replacement
  • lung operations
  • colonic resection
  • radical neck dissection

 

Reference:


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