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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.
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.
Why: Some medicines, such as diuretics or anticoagulants, make particular tests worthwhile.
“Take into account any medicines people are taking when considering whether to offer any preoperative test.”
NICE 2016 · Not graded (NICE 1.2.1)
Why: These tests rarely change the plan when done routinely, and abnormal results can lead to delays and more tests.
“Do not routinely offer chest X‑rays before surgery.”
NICE 2016 · Not graded (NICE 1.8.1)
Why: In these people a heart scan can change how the anaesthetic is given.
“Before ordering the resting echocardiogram, carry out a resting electrocardiogram (ECG) and discuss the findings with an anaesthetist.”
NICE 2016 · Not graded (NICE 1.9.2)
Why: Poorly controlled diabetes raises the risk of complications and can often be improved before planned surgery.
“Offer HbA1c testing to people with diabetes having surgery if they have not been tested in the last 3 months.”
NICE 2016 · Not graded (NICE 1.6.2)
Why: Anaemia, kidney problems and heart rhythm problems matter more as the operation gets bigger.
NICE 2016 · Table 3 (major or complex surgery): full blood count Yes at every ASA grade; kidney function and ECG Yes at ASA 2 and ASA 3 or 4, Consider at ASA 1
Why: Clotting tests rarely change care unless the liver is affected; blood thinners need their own plan, and newer ones do not show on routine tests.
“Note that currently the effects of direct oral anticoagulants (DOACs) cannot be measured by routine testing.”
NICE 2016 · Table 2 and Table 3: Not routinely at ASA 1 and 2; Consider in people with chronic liver disease
Why: Asking finds people who need specialist planning without testing everyone.
“Ask the person having surgery if they or any member of their family have sickle cell disease.”
NICE 2016 · Not graded (NICE 1.4.2)
Why: Anaesthesia and surgery can harm a pregnancy, and some cancer surgery would be planned differently.
“Carry out a pregnancy test with the woman's consent if there is any doubt about whether she could be pregnant.”
NICE 2016 · Not graded (NICE 1.3.4)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
NICE NG45 (2016): tests chosen by surgery grade and ASA grade, with chest X-ray, echocardiography, urine dipstick, sickle cell testing and HbA1c in people without diabetes not done routinely, and a full blood count before all major or complex surgery. It is the only guideline read here, so no disagreement can be shown.
| Recommendation | Grade, as printed | Source |
|---|---|---|
| No routine resting echocardiography “Do not routinely offer resting echocardiography before surgery.” | Not graded (NICE 1.9.1) | NICE 2016 |
| No routine urine dipstick “Do not routinely offer urine dipstick tests before surgery.” | Not graded (NICE 1.7.1) | NICE 2016 |
| No routine HbA1c in people without diagnosed diabetes “Do not routinely offer HbA1c testing before surgery to people without diagnosed diabetes.” | Not graded (NICE 1.5.1) | NICE 2016 |
| No routine sickle cell testing “Do not routinely offer testing for sickle cell disease or sickle cell trait before surgery.” | Not graded (NICE 1.4.1) | NICE 2016 |
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy), Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations.
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy).
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy).
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy).
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy).
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy), Blood clot prevention around cancer surgery, including extended prophylaxis after major abdominal and pelvic operations.
Shares Enhanced recovery after liver surgery (ERAS pathway for hepatectomy).