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 (What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature, Czoski‑Murray C et al. 2012). However, there remains a concern that some unnecessary tests continue to be requested. According to Hospital Episode Statistics 2012–13 (Health and Social Care Information Centre) the NHS in England completed 10.6 million operations compared with 6.61 million in 2002–03 (Hospital Episode Statistics 2002–03 Health and Social Care Information Centre), 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).

More information

You can also see this guideline in the NICE pathway on preoperative tests.

To find out what NICE has said on topics related to this guideline, see our web page on surgical care.

See also the guideline committee's discussion and the evidence reviews (in the full guideline), and information about how the guideline was developed, including details of the committee.

  • National Institute for Health and Care Excellence (NICE)