Download or read book Preoperative Tests (update) written by and published by . This book was released on 2016 with total page 206 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2003, NICE first issued guidance on the use of routine preoperative tests for elective surgery (NICE CG3). The guideline evaluated the practice of routinely performing preoperative diagnostic tests for elective surgery in healthy and comorbid populations. Much of the evidence in the original guideline was inconclusive and a formal consensus survey about the appropriateness of preoperative testing was conducted to inform the recommendations made by the Guideline Development Group (GDG). Since the guideline was issued there has been a reduction in the ordering of routine tests for young, healthy patients undergoing minor surgery, however there remains a concern that unnecessary tests continue to be requested. Excessive testing can cause significant anxiety in patients, delays in treatment and unnecessary, costly, and possibly harmful treatments. Moreover, even genuinely abnormal results often do not result in any significant change in perioperative management in relatively healthy patients. In 2012/13 the NHS in England completed 10.6 million operations compared with 6.61 million in 2002/03: an increase of 60%. Therefore even a small percentage of unnecessary testing can affect large numbers of patients. Preoperative tests provide a benefit where they yield additional information that cannot be obtained from a patient history and physical examination alone, and also where they: 1. help to assess the risk to the patient and inform discussions about the risks and benefits of surgery2. allow the patient's clinical management to be altered, if necessary, in order to reduce possible harm or increase the benefit of surgery3. help to predict postoperative complications4. establish a baseline measurement for later reference where potentially abnormal postoperative test results cannot be adequately interpreted in isolation.48 Since the original NICE guideline was issued in 2003, preoperative assessment has changed radically. In the past preoperative tests were requested by junior medical staff in anticipation of, and readiness for, an assessment by an anaesthetist shortly before surgery. Currently most patients are seen well in advance of surgery in a preoperative assessment clinic, where a structured history and targeted examination are performed by experienced nursing staff according to protocols developed by anaesthetists. Early preoperative assessment by nurses can determine the patient's functional status, which remains a major determinant of perioperative risk, and has been shown to reduce the number of investigations which are requested. In light of these developments, it is clear that an update to the guideline is required. However a review of newly published evidence highlighted the paucity of high quality studies evaluating the benefit of routine preoperative testing in adults undergoing elective non-cardiac surgery. For this reason a modified Delphi consensus survey was undertaken to re-evaluate the usage of routine preoperative tests amongst clinicians, which helped the GDG update and revise the recommendations made in 2003. A number of other developments have occurred since 2003 and are reflected in the scope of this update. Random blood glucose has been largely abandoned in the detection and optimisation of diabetes mellitus and replaced by glycated haemoglobin (HbA1c). Several new preoperative tests are increasingly used in patients undergoing elective surgery (for example non-invasive cardiac stress tests, cardiopulmonary exercise testing, polysomnography). It is hoped that these tests may provide more information on the best form of perioperative management and assist the prediction of postoperative complications in certain higher risk patients. In a final change from the 2003 guideline, children, and patients undergoing cardiothoracic procedures or neurosurgery, are populations not covered by this update because their management is highly specialised and specialist guidance exists elsewhere.