What are the guidelines for referring patients with complex medical histories to an anaesthetist before surgery?

For patients with complex medical histories, specific guidelines indicate when an anaesthetist should be involved prior to surgery.

• Direct Consultation for Cardiac Symptoms: If a patient has a heart murmur and any cardiac symptom (such as breathlessness, pre-syncope, syncope, or chest pain) or signs/symptoms of heart failure, a resting electrocardiogram (ECG) should be carried out, and the findings discussed with an anaesthetist before ordering a resting echocardiogram ².
• Consideration of Comorbidities in Anaesthetic Assessment: The American Society of Anesthesiologists (ASA) Physical Status Classification System is used to describe a person's fitness to undergo an anaesthetic ². Anaesthetists in the UK often interpret these ASA grades in relation to functional capacity, specifically how comorbidity (complex medical history) limits a person's activity (e.g., ASA 3) ². This implies that patients with significant comorbidities are assessed by anaesthetists as part of their fitness for surgery.
• Information Sharing for Surgical Consultation: When referring people with diabetes for surgical consultation from primary care, their most recent HbA1c test results should be included in the referral information ². This ensures relevant details of complex medical conditions are available for the surgical team, including anaesthetists.
• Preoperative Assessment and Risk Stratification: For all surgeries, including those for patients with complex medical histories, a validated risk stratification tool should be used to supplement clinical assessment ¹. The person's risks and surgical options should be discussed with them to facilitate informed shared decision-making ¹. Enhanced recovery programmes, which include preoperative components, are offered for elective major or complex surgery ¹.