Excerpt

The guideline is aimed mainly at secondary care, but may have relevance to some tests carried out or ordered in primary care. The preoperative tests considered are for the preoperative assessment of patients classified as ASA grade 1 (adults and children) and ASA grades 2 and 3 (adults only) undergoing elective surgery. The preoperative tests to be considered were agreed at scoping meetings with the Guieline Development Group and include: chest x-ray, resting ECG, full blood count, haemostasis tests, renal function tests, blood glucose test, urine 'dipstick' test, sickle cell test, pregnancy test, blood gases (phase B only), pulmonary function tests (phase B only) .

Contents

• Guideline Development Group Membership and Acknowledgements
• Abbreviations and Glossary of Terms
• 1. Introduction
  • 1.1 Background
  • 1.2 Objectives of the guideline
  • 1.3 The purpose of the guideline
  • 1.4 Who developed the guideline?
  • 1.5 Scope of the guideline
  • Reference List
• 2. Methods
  • 2.1 Outline of methods used
  • 2.2 Assembly of an advisory group
  • 2.3 Aims and scope of the guideline
  • 2.4 Systematic review methods
  • 2.5 Economic review of the cost of tests included in the guideline
  • 2.6 Choice of development method by formal consensus
  • 2.7 Testing the assumptions: informal consensus interviews with surgical trainees and consultant anaesthetists
  • 2.8 Consensus: selection of consensus panel
  • 2.9 Development of the consensus questionnaire
  • 2.10 Consensus: round 1 – initial rating
  • 2.11 Consensus: round 2 – meeting
  • 2.12 Drafting the guideline
  • 2.13 Adjustments made in light of comments from stakeholders
  • Reference List
• 3. Findings from the Systematic Review of the Literature
  • 3.1 Papers identified for the review
  • 3.2 Preoperative chest x-rays
  • 3.3 Preoperative ECGs
  • 3.4 Preoperative haemoglobin, haematocrit and full blood count (FBC) tests
  • 3.5 Preoperative haemostasis tests
  • 3.6 Preoperative biochemistry tests
  • 3.7 Preoperative urine tests
  • 3.8 Preoperative pregnancy tests
  • 3.9 Preoperative sickle cell disease/trait tests
  • 3.10 Preoperative lung function tests
  • 3.11 Preoperative blood gas tests
  • Reference
• 4. Interview Results: Testing the Assumptions
  • 4.1 Interview part 1: reasons for testing
  • 4.2 Interview part 2: physiological models
  • 4.3 Interview part 3: sickle cell testing
  • 4.4 Interview part 4: pregnancy testing
  • Reference
• 5. Consensus Results
  • 5.1 Membership of consensus panels
  • 5.2 Development of the consensus questionnaire
  • 5.3 First round of consensus
  • 5.4 Second round: consensus meetings
  • 5.5 Presentation of results
  • 5.6 General comments and assumptions made by the panellists
  • 5.7 Definitions of consensus and key to the results tables
  • 5.8 Chest x-ray (radiograph)
  • 5.9 Resting electrocardiogram (ECG)
  • 5.10 Full blood counts
  • 5.11 Haemostasis tests
  • 5.12 Renal function tests
  • 5.13 Random blood glucose tests
  • 5.14 Urine analysis
  • 5.15 Testing of blood gases (ASA grades 2 and 3 only)
  • 5.16 Lung function tests
  • 5.17 Tests for sickle cell disease/trait
  • 5.18 Pregnancy testing
  • Reference
• 6. Guideline for Preoperative Investigations in Patients Undergoing Elective Surgery
  • 6.1 Types of recommendation
  • 6.2 Level of evidence and grading for recommendations
  • 6.3 How to use this guideline
  • 6.4 ASA grade 1
  • 6.5 ASA grade 1
  • 6.6 ASA grade 2
  • 6.7 ASA grade 3
  • 6.8 ASA grade 2
  • 6.9 ASA grade 3
  • 6.10 ASA grade 2
  • 6.11 ASA grade 3
  • 6.12 Grade 1 surgery
  • 6.13 Grade 2 surgery
  • 6.14 Grade 3 surgery
  • 6.15 Grade 4 surgery
  • 6.16 Neurosurgery
  • 6.17 Cardiovascular surgery
  • 6.18 Tests for the sickle cell gene in adults and children
  • 6.19 Pregnancy testing
  • 6.20 Good practice recommendations
  • 6.21 Implementation in the NHS
  • 6.22 Audit criteria
  • 6.23 Costs and cost-effectiveness
  • Bibliography
• 7. Discussion and Research Recommendations
  • 7.1 Limitations of the guideline
  • 7.2 Issues not considered in the development of the guideline
  • 7.3 Research recommendations
• Appendices
  • Appendix 1 Results of a Systematic Review of the Literature for Routine Preoperative Testing
  • Appendix 2 Examples of Surgical Procedures by Severity Grading
  • Appendix 3 Phase A Consensus Questionnaire (Results)
  • Appendix 4 Phase B Consensus Questionnaire (Results)
  • Appendix 5 Economics of Routine Preoperative Testing