05 April 2016
NICE publishes updated clinical guideline on routine preoperative tests
The National Institute for Health and Care Excellence (NICE) has today published updated, simplified guidance on the use of the tests some people need before they have planned surgery.
The guideline recommends reducing the number of routine tests used in healthy patients. It also recommends that the results of tests people have at their GP’s should be available when they are referred for surgery.
The updated guideline strengthens the previous recommendations on pregnancy testing, saying it should be carried out when there is any doubt about whether a woman may be pregnant.
Ian Smith, senior lecturer in anaesthesia, consultant anaesthetist and chair of the guideline group, said: “Too much preoperative testing may cause anxiety in patients, delays in treatment and further unnecessary treatments without influencing outcome or changing how patients are managed during surgery. We have therefore extensively revised and simplified the original 2003 NICE guidance.
“Under the new guidance, patients who are reasonably healthy or having relatively non-invasive surgery should need few, if any, preoperative tests. An important new recommendation is that the results of tests patients have in primary care are included when they are referred for surgical consultation so that tests aren’t repeated unnecessarily.
“We are also recommending that anaesthetists are consulted before some specialised tests, such as echocardiograms and lung function tests, are requested.”
Since the original NICE guideline was issued in 2003, preoperative assessment has changed radically and this is reflected in the updated guideline. For example, random blood glucose testing to see if someone has diabetes has largely been discontinued while new tests, such as echocardiography, are being used more.
Most patients are now seen well in advance of surgery in nurse-led preoperative assessment clinics where a detailed medical history is taken and a physical examination carried out to see if patients are fit enough to have surgery and an anaesthetic. Their use has reduced the amount of preoperative tests requested.
Professor Mark Baker, clinical practice director for NICE, said: “Although there has been a reduction in the number of routine tests for young, healthy patients having planned minor surgery since our original guideline was published, we do know that unnecessary tests continue to be requested.
“When you consider that in 2014/2015 the NHS in England carried out 9.9 million operations, it’s apparent that even a small percentage of unnecessary testing can affect large numbers of patients and have a significant impact on costs.
“This updated guideline will help bring further clarity about what tests should be requested for which patients and therefore enable clinicians to focus resources only where they are most likely to provide information that can’t be obtained from a patient history and physical examination alone and have a positive impact on the care a patient receives.”
Audrai Morgan, pre-assessment lead nurse and guideline group member, said: “This updated guideline is a valuable tool that will enable healthcare professionals undertaking preoperative assessment to feel confident that the tests they are doing are the right ones for finding out whether patients are fit to have surgery. Just as importantly, it will help to ensure the best possible post-operative outcomes for patients.”
Hasan Mukhtar, consultant general and colorectal surgeon and guideline group member, said: “The updates to this guideline have made it simper to use while at the same time ensuring it remains comprehensive. In making clear recommendations on what preoperative tests to use according to the complexity of the operation and the health of the patient, the updated guideline will help to reduce the unnecessary cancellation of planned surgery.”
Ends
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Notes to Editors
About the guidance
- The guideline will be available at www.nice.org.uk/guidance/ng45 from Wednesday 6 April 2016. Embargoed copies of the guideline are available from the NICE press office on request.
- The guideline makes recommendations about which patients should routinely be offered the following tests:
- Full blood count (for example to test for anaemia)
- Kidney function
- Lung function and arterial blood gas analysis
- Resting electrocardiography (ECG)
- Resting echocardiography
- Glycated haemoglobin (HbA1c) [to test for diabetes or to assess how well diabetes is being controlled]
- Haemostasis tests (to test how well the blood clots)
- Chest X-ray
- Urinalysis (for example to test for urinary infections or kidney problems)
- Pregnancy testing
- Sickle cell disease/trait tests.
- The guideline group found there was insufficient evidence to make recommendations about the following tests for routine preoperative assessment:
- Cardiopulmonary exercise test (CPET)
- Polysomnography (to detect obstructive sleep apnoea).
- In a change from the 2003 guideline, children, and patients undergoing cardiothoracic procedures or neurosurgery, are populations not covered by this update because their management is highly specialised and specialist guidance exists elsewhere.
- A review of newly published evidence as part of the guideline update highlighted the paucity of high quality studies evaluating the benefit of routine preoperative testing in adults undergoing elective non-cardiac surgery. For this reason a modified Delphi consensus survey was undertaken to re-evaluate the usage of routine preoperative tests amongst clinicians, which helped the GDG update and revise the recommendations made in 2003.
About preoperative tests
- Preoperative tests are used for some people having surgery to see if they have any medical problems that might need to be treated before surgery, or whether they might need special care during or after surgery.
- Preoperative tests are also used to help determine what the risks are of anything going wrong during or after surgery and to inform discussions between clinicians and patients about those risks versus the benefits of surgery. They can also allow for changes to be made to the treatment a person receives to reduce possible harm or increase the benefit of surgery, as well as help to predict any complications after surgery.
- The tests people need depend on the type of surgery they are having and whether they have any other illnesses (comorbidities). People with comorbidities, such as cardiovascular disease, lung disease or kidney disease, have a higher risk of complications during and after surgery.
About NICE
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.
To find out more about what we do, visit our website: http://www.nice.org.uk and follow us on Twitter: @NICEComms.
About NICE
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.
To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.