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

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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	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:

NICE (April 2016). Routine preoperativative tests for elective tests for elective surgery

ASA (American Society of Anesthesiologists) Physical Status Classification System

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

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