What preoperative assessments are recommended for patients undergoing elective surgery in primary care?

Preoperative assessments recommended for patients undergoing elective surgery in primary care include a thorough clinical assessment supplemented by validated risk stratification tools to evaluate surgical risks and enable shared decision making with the patient.

Routine preoperative tests such as full blood count, kidney function tests, and coagulation screens should be considered based on the patient's comorbidities and the type and grade of surgery planned.

HbA1c testing is recommended only for patients with diagnosed diabetes, ensuring recent results (within 3 months) are included in referrals; it is not routinely offered to those without diabetes.

Urine dipstick tests and chest X-rays are not routinely recommended unless specific clinical indications exist, such as suspected urinary tract infection or cardiac symptoms.

Resting ECG is advised before surgery, and resting echocardiography should be considered if the patient has a heart murmur combined with cardiac symptoms or signs of heart failure, after ECG and anaesthetist consultation.

Pregnancy status should be sensitively assessed in women of childbearing potential on the day of surgery, with pregnancy testing performed if there is any doubt.

Preoperative nutritional screening is advised for patients undergoing intermediate or major/complex surgery.

Lifestyle factors such as smoking and alcohol consumption should be discussed and optimised preoperatively.

Medication review is essential, including anticoagulants and contraceptive methods, with appropriate management plans for perioperative periods.

All preoperative test results performed in primary care should be included in the surgical referral to ensure continuity of care.

Enhanced recovery programmes should be offered for patients undergoing major or complex elective surgery, incorporating preoperative, intraoperative, and postoperative components.