What are the recommended pre-operative assessments for patients undergoing elective general surgery?

Recommended pre-operative assessments for patients undergoing elective general surgery include a tailored approach based on the type and complexity of surgery, patient comorbidities, and functional status. Routine tests are not universally required but should be considered as follows:

• Full blood count to assess haemoglobin and other parameters as clinically indicated.
• HbA1c testing for patients with diabetes if not tested within the last 3 months; not routinely for those without diabetes.
• Kidney function tests including estimated glomerular filtration rate, electrolytes, and creatinine as appropriate.
• Electrocardiography (ECG) for cardiac risk assessment, especially in patients with cardiovascular disease or risk factors.
• Resting echocardiography only if the patient has a heart murmur plus cardiac symptoms or signs of heart failure, after ECG and anaesthetist consultation.
• Chest X-ray is not routinely recommended before surgery.
• Urine tests are not routinely recommended unless a urinary tract infection would influence surgical decisions.
• Pregnancy testing should be sensitively offered to women of childbearing potential on the day of surgery if pregnancy status is uncertain.
• Nutritional screening is advised for patients undergoing intermediate or major/complex surgery.
• Assessment of comorbidities such as cardiovascular, respiratory, renal, diabetes, and obesity should guide further investigations and optimisation.
• Use of validated risk stratification tools to supplement clinical assessment and support shared decision making.

Communication with patients about the purpose and implications of tests, and inclusion of test results in surgical referrals, is essential. Preoperative optimisation, including lifestyle advice and management of anaemia, should be considered where appropriate.

These recommendations are stratified by surgery grade (minor, intermediate, major/complex) and ASA physical status classification to guide the extent of preoperative assessment.

In summary: Preoperative assessment should be individualised, focusing on relevant blood tests, ECG, selective imaging, pregnancy status, nutritional screening, and risk stratification, avoiding routine testing without clinical indication.

References: ¹,²