HNY Policy and Pathway Repository - East Riding

Assessing fitness of adult, elective surgical patients prior to routine surgery

This intervention is commissioned for patients with:

• an American Society of Anaesthesiologists (ASA) physical classification status of 3 or greater AND no ECG results available for review in the last 12 months AND being assessed for minor, major or intermediate surgery OR
• an American Society of Anaesthesiologists (ASA) physical classification status of 2 or greater AND a history of cardiovascular or renal disease, or diabetes AND being assessed for intermediate or major surgery OR
• any history of potential cardiac symptoms (e.g. cardiac chest pain, palpitations, unexplained syncope or breathlessness) or a new murmur, that has not previously been investigated AND being assessed for intermediate or major surgery OR
• age of 65 years or older being assessed for major surgery

 

This intervention is not otherwise commissioned for low risk, non-cardiac, adult elective surgical patients.

 

N.B. examples of minor, intermediate and major surgery:

Minor: excising skin lesion, draining breast abscess

Intermediate: primary repair of inguinal hernia, excising varicose veins in the leg, tonsillectomy, knee arthroscopy

Major: total abdominal hysterectomy, endoscopic resection of prostate, lumbar discectomy, thyroidectomy, total joint replacement, lung operations.

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 (Czoski Murray et al. 2012). However, there remains a concern that some unnecessary tests continue to be requested. According to NHS Digital's Hospital Episode Statistics, Admitted Patient Care, England - 2012–13, the NHS in England completed 10.6 million operations compared with 6.61 million in 2002–03 (see NHS Digital's Hospital Episode Statistics 2002–03), an increase of 60%. Therefore even a small percentage of unnecessary preoperative testing can affect a large number of people.

Pre-operative electrocardiogram (ECG) - EBI

NG45 Routine preoperative tests for elective surgery NICE