# Routine tests before planned surgery, by size of operation and fitness

Source: https://onco.cc/protocols/routine-preoperative-tests/  
OnCo record `routine-preoperative-tests` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Before a planned operation, tests should be chosen for the person and the size of the operation, not done for everyone. A blood count is offered before major surgery; a heart tracing and kidney tests depend on age, health and the operation; a chest X-ray, urine dipstick or heart scan is not done routinely.

## Summary

NICE NG45 (2016) sets which routine tests to offer before elective surgery by surgery grade (minor, intermediate, major or complex) and ASA grade. Not routinely before any surgery: chest X-ray, resting echocardiography (consider it for a murmur with cardiac symptoms, or signs of heart failure, after an ECG and anaesthetic discussion), urine dipstick (consider midstream urine culture if a urinary infection would change the decision), sickle cell testing (ask about it instead), and HbA1c in people without diabetes. Offer HbA1c to people with diabetes not tested in the last 3 months. Before major or complex surgery: full blood count for all ASA grades; ECG for ASA 2 and above, and considered over 65 at ASA 1 without an ECG in the last year; kidney function for ASA 2 and above, and considered in ASA 1 at risk of acute kidney injury. Clotting tests are not routine; consider them in chronic liver disease, and make an individual plan for anticoagulants, noting that DOAC effects cannot be measured by routine tests. Ask about pregnancy on the day of surgery and test with consent if in doubt. Take existing medicines into account. People with cancer often have recent blood tests from their treatment; NG45 does not address chemotherapy or recent cancer treatment.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: preoperative tests; pre-op bloods; pre-assessment tests; preoperative investigations; routine chest X-ray before surgery; preoperative ECG

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