preoperative tests niceguideline

7/28/2019 Preoperative Tests NICEguideline

1/18

N0231 25k 1P Jun 03 (OAK)

Preoperative tests

The use of routine preoperative

tests for elective surgery

Clinical Guideline 3

June 2003

Developed by the National Collaborating

Centre for Acute Care

National Institute forClinical Excellence

MidCity Place

71 High Holborn

London

WC1V 6NA

ww w.nice.org.uk


2/18

National Institute forClinical Excellence

MidCity Place

71 High Holborn

London

WC1V 6NA

www.nice.org.uk

Natio na l Institu te fo r Clinical Excellence, June 2003. All right s reserved . This

material may be f reely reproduced for educat iona l and not-for-prof it purposes

with in the NHS. No reproduction by or for commercial orga nisations is allow ed

with out th e express w ritten permission of the Nat iona l Institute for Clinical

Excellence.

Clinical Guideline 3Preoperative testsThe use of routine preoperative tests for elective surgery

Issue date: June 2003

To order copiesCopies of this guideline can be ordered from the NHS Response Line;

telepho ne 0870 1555 455 and quo te refe rence numb er N0231. A version f orpeople who wa nt to understand w hat NICE has told the NHS, called Routinetests carried out before a planned surgical operation, is also available fromthe Response Line; quote reference number N0232 for an English only

version a nd N0233 for a n English and Welsh version.

This guidance is written in the following context.

This guida nce represents the view o f the Institute, wh ich was arrived at

af ter careful considerat ion of the evidence ava ilable . Health professionals

are expected to t ake it fully into a ccount w hen exercising their clinical

judgment . The guida nce does not, how ever, override the individual

responsibility of health professionals to make decisions appropriate to thecircumstances of the individual pat ient , in consultat ion w ith the pat ient

and /or gua rdian o r carer.

ISBN: 1-84257-309-8

Published by the National Institute for

Clinical Excellence

June 2003

Artw ork by LIMA Gra phics, Frimley, Surrey

Printed by Oaktree Press, London

This documen t has been circulated t o the follow ing:

NHS trust chief executives in Englan d a nd Wales PCTchief executives

Local health board chief executives

Medical and nursing directors in England and Wales

Strategic health authority chief executives in England and Wales

Clinical governance leads in England and Wales

Hospital doctors

Anaesthet is ts and paediat r ic a naesthet ists

Surgical consultant s (all specialties)

Imaging specialists

NHS Director Wales

Chief Executive of t he NHS in Englan d

Special health authority chief executives

Community health councils in England and Wales

Service user advocacy groups

Commission for Health Improvement NHS Clinical Govern an ce Support Tea m

Chief Medical, Nursing and Pharmaceutical Officers in England and Wales

Medical Director &Hea d of NHS Quality Welsh Assembly Go vernment

Representative bodies for health services, professional organisations and

statutory bodies and the Royal Colleges


3/18

1NICE guideline Preopera tive t ests

Contents

1 Guidance 2

Grade 1 surgery 5

Grade 2 surgery 9

Grade 3 surgery 13

Grade 4 surgery 17

Neurosurgery 21

Cardiovascular surgery 22Tests for t he sickle cell gen e in a dults a nd children 23

Pregnancy tes t 24

Pat ient consent 25

2 Notes on the scope of the guidance 26

3 Implementation in the NHS 26

4 Research recommendations 27

5 Full guideline 27

6 Related NICE guidance 28

7 Review 28

Appendix A: The Guideline Developm ent G roup 28

Appendix B: The Guidelines Advisory Committe e 29

This guideline ma kes recommend at ions to help guide the a ppropriate use of routine

preoperative tests for patients before elective surgery for children (ASA grade 1) and

ad ults (ASA grade s 1, 2 and 3). The g uideline is aimed ma inly at seconda ry care, but

may have relevance to some tests carried out or ordered in primary care.

The follow ing guida nce is ba sed upon the be st availab le evidence. All of the

recommendat ions are grad e D recommendat ions , which are b ased upon level IV

evidence*

that is, expert opinion derived from a consensus development process

and the clinical experience of the G uideline Development G roup. The full guideline

(see Section 5) describes the methods used to develop the recommendations. Inaddit ion, the views of NHS clinicians w ere sought on the fo rmat a nd usability of

these recommenda t ions , and informed the development of this booklet .

*For more information, see NICE (2001) Information for National Collaborating Centres

and Guideline Development Groups. Available fro m: ww w.nice.org.uk/Docref.asp?d= 25652


4/18

3NICE guideline Preopera tive t ests2 NICE guideline Preopera tive t ests

Box 2 ASA grades

ASA (American Society o f Anesthesiologists) grades a re a simple scale d escribing f itness

to und ergo a n ana esthetic. The ASA clearly sta tes that it do es not endo rse any

elaborat ion of t hese def init ions . However, ana esthet is ts in the UK of ten q ualify (or

interpret) these grades as relat ing to funct ional capa city that is comorbidity that do es

not (ASA Grad e 2) or tha t do es (ASA Grad e 3) limit a pat ients activity (see Box 3).

ASA G rade 1 N ormal hea l t hy p a t ien t ( t ha t i s wi t hout any c l in ica l ly

important comorbidity and without clinically s ignif icant

past/present m edical h istory)

ASA G rade 2 A p a t ien t wi t h mild syst emic d iseas e

ASA Grade 3 A pat ient with severe systemic disease

ASA Grade 4 A pat ient w ith severe systemic disease that is a constant threa t to l i fe

Box 1 Surgery grades

Example

G ra d e 1 (m in o r) Exc isi on o f le si on o f sk in ; d r a in a g e o f b re a st a b sc ess

Grad e 2 Primary repair of inguina l hernia; excision of varicose vein(s)

(i nt e rm e d ia t e ) o f le g ; t o n si ll ec to m y /a d e n o to n si ll ec to m y ; k ne e a r t hr o sc op y

Grad e 3 Tota l ab dom inal hysterectomy; endo scopic resection of

(ma jo r) prost a te ; lumba r d iscecto my; t hyro id ect omy

Grad e 4 Tota l joint replacement ; lung opera tions; colonic resection;(ma jo r+ ) ra d ica l neck d issect io n

Neurosurg ery

Cardiovascular

surgery

1 Guidance

The recommen da tions are in the form of loo k-up tab les. For the fo llowing t ests the ta bles

are set out by surgery grade (see Box 1) and ASA grade (see Boxes 2 and 3).

Plain chest X-ray (radiograph) Resting electrocardiogram (ECG) Full blood count Haemostasis including prothrombin t ime, act ivated pa rt ial thromboplast in t ime and

internat ional norma lised rat io

Renal function (including t ests for pot assium, sodium, crea tinine a nd/or urea levels) Random blood glucose

Urine analysis (urine d ipstick tests test fo r pH, protein, g lucose, ketones,blood /hae mog lobin)

Blood gases for ASA grades 2 and 3 only Lung function (peak expiratory f low rate , forced vital capacity and forced expiratory

volume) for ASA grad es 2 and 3 only.

There a re also recommend at ions for sickle cell test an d pregn ancy test.

The recommen da tions are colour-coded in a similar wa y to traff ic lights.

For the ta bles set out by surgery grade and ASA grade, ag e catego ries are shown

across the top of each tab le . For a pa t ient with more tha n one comorbidity, follow

the recommendat ions in all relevant t a bles.

Test not recom mend ed

Test to be considered (the value of carrying out a preopera tive test is not know n,

and may depend on specific patient characteristics)

Test recommend ed


5/18

5NICE guideline Preopera tive t ests

Grade 1 surgery (minor)

4 NICE guideline Preopera tive t ests

Grade 1 surgery

Age

Test

Chest X-ra y No No No No No

ECG No No No No No

Full b loo d co unt No No No No No

Ha emost a sis No No No No No

Rena l f unct ion No No No No No

Ra nd om g lucose No No No No No

Urine ana lysis* No No No No No

*Dipstick urine testing in asymptomatic individuals is not

recommended (UK National Screening Committee)

100 mol/litre (creat inine > 200 mol/litre);

an d < 200 mol/litre); some regular dialysis progra mme,

d ieta ry rest rict io ns (perit on ea l o r h aem od ia lysis)

COAD, chronic obstructive airw ays disease; COPD, chronic obstructive pulmona ry

disea se; GTN, glyceryl trinit rat e

Further examples are available in Appendix 2 of the full guideline (see Section 5)

16to

preoperative tests niceguideline

Documents