Routine preoperative tests for elective surgery

Context

In 2003, NICE first issued guidance on the use of routine preoperative tests for people having elective surgery. Many apparently healthy people are tested before surgery to check for undetected conditions that might affect their treatment. This can provide a benefit where test results yield additional information that cannot be obtained from a patient history and physical examination alone. However, excessive preoperative testing can cause significant anxiety, delays in treatment and unnecessary, costly and possibly harmful treatments when false positive results are obtained. Even genuinely abnormal results often do not result in any significant change in perioperative management in relatively healthy people.

Since 2003 there has been a reduction in the ordering of routine tests for young, healthy people having minor surgery (Czoski Murray et al. 2012). However, there remains a concern that some unnecessary tests continue to be requested. According to NHS Digital's Hospital Episode Statistics, Admitted Patient Care, England - 2012–13, the NHS in England completed 10.6 million operations compared with 6.61 million in 2002–03 (see NHS Digital's Hospital Episode Statistics 2002–03), an increase of 60%. Therefore even a small percentage of unnecessary preoperative testing can affect a large number of people.

Over the past 12 years preoperative assessment has changed radically. Most people are now seen well in advance of surgery in a preoperative assessment clinic, where a structured history and targeted examination are performed by experienced nursing staff. Some preoperative tests have been abandoned in favour of others (for example random blood glucose in favour of HbA1c), while new tests have been developed that are increasingly being used in some people having elective surgery (for example non‑invasive cardiac stress tests, cardiopulmonary exercise test and polysomnography).