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Pre-operative assessment

Checked: 23-07-2023 by Rob Adams Next Review: 23-07-2025

Introduction

Many routine operations are cancelled due to modifiable pre-operative conditions including poorly controlled diabetes, poorly controlled hypertension, iron deficiency anaemia and other conditions. Pre- operative optimisation in primary and secondary care can help to reduce cancellations and improve operation outcomes.

For example, with regards to diabetes control, data from NBT anaesthetists indicates that:

288 (21%) patients per annum attending NBT preop have HbA1c > 69
Of those with HbA1c > 69 33% had their surgery delayed.
When a patient is delayed the mean time of delay is 5mths.
The evidence is that HbA1c increases morbidity/joint infections and length of stay.
NICE and Diabetic societies have produced guidelines stating that patients with HbA1c > 69 should be delayed if possible.

(See Power Point presentation provided by Simon Lewis (Consultant Anaesthetist and NBT Lead for pre-op assessment for further details.)

Pre-op information in Primary Care

It is increasing important that all referrals (particularly to surgical specialities) should now include the following up to date information (preferably done at time of referral or at minimum within the last 6 months)

BMI

HbA1c - if patient has diabetes or is at risk of diabetes. HbA1c should be less than 69 for routine surgery.

FBC, ferritin and UE. Anaemia should be corrected prior to surgery where possible.

Smoking status - stopping smoking prior to surgery can help to improve surgical outcomes.

Addressing these operative risk factors in primary care prior to referral or whilst awaiting first out patient appointment would be hugely beneficial to patients and secondary care colleagues.

A BNSSG ICB standard referral template is now used across BNSSG which will help to standardise the information provided in referrals.

Patient information

The Royal College of Anaesthetists provide patient resources on their website.

This includes a link to a YouTube video titled:

Preparing for surgery: Fitter Better Sooner

Preparing for an operation - NHS BNSSG ICB This information is on the BNSSG ICB website and can be given to patients. You will find stop smoking, leisure centre exercise schemes and many other local BNSSG resources on this page to support prehabilitation universal interventions. Universal means general advice or signposting to services.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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