NICE - suggested preoperative tests based on complexity of surgery and ASA classification

Last reviewed 01/2018

Suggested Investigations based on complexity of surgery and ASA classification.

ASA Classification used in this guide:

ASA 1 A normal healthy patient
ASA 2 A patient with mild systemic disease
ASA 3 A patient with severe systemic disease
ASA 4 A patient with severe systemic disease that is a constant threat to life

If Minor Surgery:

ASA 1 ASA2 ASA3 or ASA4
Full blood count Not routinely Not routinely Not routinely
Haemostasis Not routinely Not routinely Not routinely
Kidney Function Not routinely Not routinely Consider in people at risk of AKI
ECG Not routinely Not routinely Consider if no ECG results available from past 12 months
Lung function/arterial blood gas Not routinely Not routinely Not routinely

If Intermediate Surgery:

 

  ASA 1 ASA2 ASA3 or ASA4
Full blood count Not routinely Not routinely Consider for people with cardiovascular or renal disease if any symptoms not recently investigated
Haemostasis Not routinely Not routinely

Consider in people with chronic liver disease

  • if people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance
  • if clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing
Kidney Function Not routinely Consider in people at risk of AKI Yes
ECG Not routinely Consider for people with cardiovascular, renal or diabetes comorbidities Yes
Lung function/arterial blood gas Not routinely Not routinely Consider seeking advice from a senior anaesthetist as soon as possible after assessment for people who are ASA grade 3 or 4 due to known or suspected respiratory disease

 

If Major/Complex Surgery:

ASA 1 ASA2 ASA3 or ASA4
Full blood count Yes Yes Yes
Haemostasis Not routinely Not routinely

Consider in people with chronic liver disease

  • if people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance
  • if clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing
Kidney Function Consider in people at risk of AKI Yes Yes
ECG Consider for people aged over 65 if no ECG results available from past 12 months Yes Yes
Lung function/arterial blood gas Not Routinely Not Routinely Consider seeking advice from a senior anaesthetist as soon as possible after assessment for people who are ASA grade 3 or 4 due to known or suspected respiratory disease

Notes:

  • Surgery Grades:

    Surgery Grades Examples
    Minor
    • excising skin lesion
    • draining breast abscess

     
    Intermediate
    • primary repair of inguinal hernia
    • excising varicose veins in the leg
    • tonsillectomy or adenotonsillectomy
    • knee arthroscopy
    Major or Complex
    • total abdominal hysterectomy
    • endoscopic resection of prostate
    • lumbar discectomy
    • thyroidectomy
    • total joint replacement
    • lung operations
    • colonic resection
    • radical neck dissection

 

Reference:

Related pages:

ASA grades