Routine Preoperative Win
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Pre Admission Assessment Clinics (PAAC)
Guideline on routine preoperative investigations
Click here to begin
Introduced July 2009. Please email Martin Millar with feedback on these guidelines
Preoperative Tests Click a box to select
Start Guidance Frequently asked questions List of procedures Exit
Patient age? How old is the patient?
Less than 60 years Between 60 and 80 years Greater than 80 years Return to start
Exit
Patient <60 years, surgery severity? What is the grade of surgery?
Minor Surgery Intermediate Surgery Major Surgery Major Plus Surgery Back one screen
List of procedures
Return to start
Patient <60 years, minor or intermediate surgery
Patient health status:
Fit & well Cardiovascular disease Renal Disease Back one screen
Return to start
Exit
<60,minor,fit
Patient < 60 years Minor or intermediate surgery No health problems
NO ROUTINE INVESTIGATIONS REQUIRED Back one screen
Return to start
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function Click here for more information
Exit
< 60, minor, CVS
Patient < 60 years Minor or intermediate surgery Cardiovascular disease Investigations required: Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG U&E
Click here for more information
Back one screen
Return to start
Exit
<60,minor,renal
Patient < 60 years Minor or intermediate surgery Renal disease Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG FBC
Back one screen
Click here for more information
Back to start
Exit
Patient <60 years, major or major plus surgery Patient health status:
No cardiovascular or renal disease Cardiovascular and / or renal disease
Back one screen
Return to start
Exit
Patient <60, major or major plus surgery,no cvs/renal
Patient < 60 years Major or Major Plus surgery No cardiovascular or renal disease Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
U&E FBC G&S*
Back one screen
Click here for more information *Consider G&S Click here for more info
Return to start
Exit
Patient <60, major or major plus surgery,CVS or renal disease
Patient < 60 years Major or Major Plus surgery Cardiovascular or renal disease Investigations required:
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
U&E FBC G&S* ECG Back one screen
*Consider G&S Click here for more info
Return to start
Click here for more information
Exit
Patient 60-80 years, surgery severity?
Minor Surgery Intermediate Surgery Major Surgery Major Plus Surgery Back one screen
List of procedures
Return to start
Exit
60-80 years, minor surgery
Fit & well Cardiovascular and /or renal disease
Back one screen
Return to start
Exit
60-80 years minor surgery,fit Patient 60-80 years Minor surgery Fit & well Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG
Click here for more information
Back one screen
Return to start
Exit
60-80 years minor surgery,CVS or renal disease Patient 60-80 years Minor surgery Cardiovascular or renal disease Investigations required:
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC
Click here for more information
U&E
Back one screen
Return to start
Exit
60-80 years intermediate surgery
Fit & well Cardiovascular and /or renal disease
Back one screen
Return to start
Exit
60-80 years intermediate surgery,fit Patient 60-80 years Intermediate surgery Fit & well Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG FBC
Back one screen
Click here for more information
Return to start
Exit
60-80 years intermediate surgery,cvs or renal Patient 60-80 years Intermediate surgery Cardiovascular or renal disease Investigations required: Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC U&E
G&S* Back one screen
*Consider G&S Click here for more info
Return to start
Click here for more information
Exit
60-80 years major / major plus surgery Patient 60-80 years Major or Major Plus surgery ALL patients require:
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC U&E G&S* Back one screen
Click here for more information *Consider G&S Click here for more info
Return to start
Exit
Patient > 80 years, Surgery Severity?
Minor Surgery Intermediate Surgery Major Surgery Major Plus Surgery Back one screen
Return to start
Exit
Patient >80 years, minor surgery Patient health status?
Fit and well Any medical problems
Back one screen
Return to start
Exit
>80 years,minor surgery,fit Patient >80 years Minor surgery Fit & well Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG
Click here for more information
Back one screen
Return to start
Exit
>80 years,minor surgery,any health problems Patient >80 years Minor surgery ANY health problems Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG FBC
Click here for more information
U&E
Back one screen
Return to start
Exit
>80 years,intermediate, major or major plus surgery,all patients Patient >80 years Intermediate, Major or Major Plus Surgery- ALL patients Investigations required: Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC U&E G&S* Back one screen
*Consider G&S Click here for more info
Return to start
Click here for more information
Exit
Other tests (1) THYROID FUNCTION If a history of, or suggestive of thyroid disease AND no documented results within the past six months LIVER FUNCTION If there is a history or suspicion of liver disease eg metastatic disease or alcohol excess COAGULATION. Only in patients with: •Known or suspected bleeding disorder •History of liver disease •Patients taking anticoagulants •Chronic renal failure PULMONARY FUNCTION •Patients with moderate / severe lung disease AND no similar tests in past six months. •Patients with breathlessness of unknown cause Back to start
More tests
Exit
Other tests (2) SICKLE CELL TEST In patients from high risk ethnic groups (see below) unless already known to have sickle cell disease or sickle cell trait. North African e.g. Egyptian West African e.g. Nigerian South / Sub Saharan African e.g. Zimbabwean Afro Caribbean PREGNANCY TEST In any woman who says it is possible that she may be pregnant CHEST X-RAY Only in patients with chest problems and a recent significant deterioration in symptoms. Consult with anaesthetist before ordering.
Back one slide
Back to start
Exit
Group & Save It is difficult to give specific guidance on what patients need a group & save. This test should be performed wherever a major body cavity will be entered (eg laparotomy) or where there is a risk of haemodynamically significant blood loss (eg hip replacement or TURP) Back one slide
Return to start
Exit
Frequently asked questions What is a routine test? A routine test is one that would be carried out for all similar patients undergoing similar operations. They may or may not be the only tests carried out but this would depend on the individual patient.
How long are tests valid for? There is no hard and fast rule for this but in general, for fit patients or those with stable medical conditions blood tests do not need to be repeated within three months. If there has been a significant change in their health then they should have the relevant tests repeated up to one month before surgery.
How long is a Group & Save valid for? Blood can only be issued within 5 days of the most recent Group & save. Most patients in whom this is indicated will therefore need this test repeated on admission.
What is the definition of cardiovascular or renal disease? For the purposes of these guidelines cardiovascular disease means any condition primarily involving the cardiovascular system (e.g. hypertension, angina). Includes suspected disease without formal verification. Renal disease refers to known renal insufficiency or serum creatinine above upper limit of normal with or without dialysis.
More
Back one screen
Back to start
Exit
Frequently asked questions (2) How do I find surgery severity on HISS? 1. PCI > View patient on theatre list
2.
PCI > Theatre Management > View Theatre Profile
Back one screen
Exit
List of procedures ENT / Facio-Maxillary General Surgery (inc Vascular) Gynaecology Ophthalmology Orthopaedics Urology To return to guidance click below for:
<60
60-80
>80
Return to start
List of procedures – ENT Minor
Intermediate
Major/Major +
Laryngoscopy / microlaryngoscopy
ORIF mandible/zygoma
Parotidectomy
Panendoscopy
Neck dissection
UVPP
Mastoidectomy
Branchial cyst excision
Bicoronal flap
Septoplasty
Bimaxillary osteotomy
SMR
Stapedectomy
Reduction fractured nose
Endoscopic sinus surgery
Tympanoplasty
Submucous diathermy(SMD)
Nasal polypectomy
Rhino/ Septorhinoplasty
Pinnaplasty
Laryngectomy
Dental extraction Tonsills/ Adenoids Lymph node biopsy Myringotomy with grommet
Palatoplasty
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Gynaecology Minor
Intermediate
Major / Major +
Hysteroscopy / D&C
Thermal endometrial ablation
Hysterectomy (all types) Vaginal repair
Diagnostic laparoscopy Biopsy / excision / diathermy vulval lesions
Laparoscopic sterilisation
Biopsy / loop excision cervix
Lap and dye
Insert / remove IUCD
Anterior colporrhaphy
Reversal sterilisation Salpingectomt Myomectomy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - General / Vascular Surgery Minor
Intermediate
Major / Major +
EUA rectum
Inguinal hernia repair (inc laparoscopic)
Aortic aneurysm repair
Vasectomy Removal skin lesion
Bowel resection
Femoral or umbilical hernia repair
Closure of ileostomy
Haemorrhoidectomy
Fem-popliteal bypass
Insert Tenckoff catheter
Laparoscopic cholecystectomy
Diagnostic laparoscopy Lymph node biopsy
Laparoscopic Nissen’s fundoplication
Removal gastric balloon
Mastectomy
Orchidopexy
Thyroidectomy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Ophthalmology Minor
Intermediate
Blepharoplasty
Major / Major +
Brow lift
Cornel graft
Cryo to lid
DCR
Enucleation
Entropion
Keratectomy
Medial canthal sling
Excision lid/skin lesion
Lamellar graft
Vitrectomy
Lateral tarsal sling
Ptosis correction
Tarsorraphy
Squint (adult)
Temporal artery biopsy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Orthopaedics Minor
Intermediate
Adjust / remove external fixator
Achilles tendon release
Botox injections
Arthroscopic meniscectomy knee
Carpal tunnel release
Diagnostic arthroscopy (all)
Major / Major + ACL repair Acromioplasty Joint replacement (primary or revision, all joints) Pelvic osteotomy
Excision ganglion Injection / MUA joint Removal K-wires
Excision radial head Metatarsal osteotomy
Removal metalware hip Spinal decompression / fusion
Remove metalware foot/ knee/ Sub-talar fusion arm/ shoulder
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Urology Minor
Intermediate
Major / Major +
Bladder neck incision
Botox injection to bladder
Cystectomy
Cystoscopy
Insertion penile prosthesis
Nephrectomy
Insertion supra-pubic catheter
Orchidectomy
Lithotripsy ureteric stone
Ilial conduit Open prostatectomy TURT/TURP
Prostatic massage Ureteric stent Urethral dilatation Vasectomy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Exit
Guideline on routine preoperative investigations
Click here to begin
Introduced July 2009. Please email Martin Millar with feedback on these guidelines
Preoperative Tests Click a box to select
Start Guidance Frequently asked questions List of procedures Exit
Patient age? How old is the patient?
Less than 60 years Between 60 and 80 years Greater than 80 years Return to start
Exit
Patient <60 years, surgery severity? What is the grade of surgery?
Minor Surgery Intermediate Surgery Major Surgery Major Plus Surgery Back one screen
List of procedures
Return to start
Patient <60 years, minor or intermediate surgery
Patient health status:
Fit & well Cardiovascular disease Renal Disease Back one screen
Return to start
Exit
<60,minor,fit
Patient < 60 years Minor or intermediate surgery No health problems
NO ROUTINE INVESTIGATIONS REQUIRED Back one screen
Return to start
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function Click here for more information
Exit
< 60, minor, CVS
Patient < 60 years Minor or intermediate surgery Cardiovascular disease Investigations required: Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG U&E
Click here for more information
Back one screen
Return to start
Exit
<60,minor,renal
Patient < 60 years Minor or intermediate surgery Renal disease Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG FBC
Back one screen
Click here for more information
Back to start
Exit
Patient <60 years, major or major plus surgery Patient health status:
No cardiovascular or renal disease Cardiovascular and / or renal disease
Back one screen
Return to start
Exit
Patient <60, major or major plus surgery,no cvs/renal
Patient < 60 years Major or Major Plus surgery No cardiovascular or renal disease Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
U&E FBC G&S*
Back one screen
Click here for more information *Consider G&S Click here for more info
Return to start
Exit
Patient <60, major or major plus surgery,CVS or renal disease
Patient < 60 years Major or Major Plus surgery Cardiovascular or renal disease Investigations required:
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
U&E FBC G&S* ECG Back one screen
*Consider G&S Click here for more info
Return to start
Click here for more information
Exit
Patient 60-80 years, surgery severity?
Minor Surgery Intermediate Surgery Major Surgery Major Plus Surgery Back one screen
List of procedures
Return to start
Exit
60-80 years, minor surgery
Fit & well Cardiovascular and /or renal disease
Back one screen
Return to start
Exit
60-80 years minor surgery,fit Patient 60-80 years Minor surgery Fit & well Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG
Click here for more information
Back one screen
Return to start
Exit
60-80 years minor surgery,CVS or renal disease Patient 60-80 years Minor surgery Cardiovascular or renal disease Investigations required:
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC
Click here for more information
U&E
Back one screen
Return to start
Exit
60-80 years intermediate surgery
Fit & well Cardiovascular and /or renal disease
Back one screen
Return to start
Exit
60-80 years intermediate surgery,fit Patient 60-80 years Intermediate surgery Fit & well Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG FBC
Back one screen
Click here for more information
Return to start
Exit
60-80 years intermediate surgery,cvs or renal Patient 60-80 years Intermediate surgery Cardiovascular or renal disease Investigations required: Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC U&E
G&S* Back one screen
*Consider G&S Click here for more info
Return to start
Click here for more information
Exit
60-80 years major / major plus surgery Patient 60-80 years Major or Major Plus surgery ALL patients require:
Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC U&E G&S* Back one screen
Click here for more information *Consider G&S Click here for more info
Return to start
Exit
Patient > 80 years, Surgery Severity?
Minor Surgery Intermediate Surgery Major Surgery Major Plus Surgery Back one screen
Return to start
Exit
Patient >80 years, minor surgery Patient health status?
Fit and well Any medical problems
Back one screen
Return to start
Exit
>80 years,minor surgery,fit Patient >80 years Minor surgery Fit & well Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG
Click here for more information
Back one screen
Return to start
Exit
>80 years,minor surgery,any health problems Patient >80 years Minor surgery ANY health problems Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
Investigations required:
ECG FBC
Click here for more information
U&E
Back one screen
Return to start
Exit
>80 years,intermediate, major or major plus surgery,all patients Patient >80 years Intermediate, Major or Major Plus Surgery- ALL patients Investigations required: Other tests may be indicated: •Thyroid function •Liver function •Coagulation •Sickle cell test •Pregnancy test •Pulmonary Function
ECG FBC U&E G&S* Back one screen
*Consider G&S Click here for more info
Return to start
Click here for more information
Exit
Other tests (1) THYROID FUNCTION If a history of, or suggestive of thyroid disease AND no documented results within the past six months LIVER FUNCTION If there is a history or suspicion of liver disease eg metastatic disease or alcohol excess COAGULATION. Only in patients with: •Known or suspected bleeding disorder •History of liver disease •Patients taking anticoagulants •Chronic renal failure PULMONARY FUNCTION •Patients with moderate / severe lung disease AND no similar tests in past six months. •Patients with breathlessness of unknown cause Back to start
More tests
Exit
Other tests (2) SICKLE CELL TEST In patients from high risk ethnic groups (see below) unless already known to have sickle cell disease or sickle cell trait. North African e.g. Egyptian West African e.g. Nigerian South / Sub Saharan African e.g. Zimbabwean Afro Caribbean PREGNANCY TEST In any woman who says it is possible that she may be pregnant CHEST X-RAY Only in patients with chest problems and a recent significant deterioration in symptoms. Consult with anaesthetist before ordering.
Back one slide
Back to start
Exit
Group & Save It is difficult to give specific guidance on what patients need a group & save. This test should be performed wherever a major body cavity will be entered (eg laparotomy) or where there is a risk of haemodynamically significant blood loss (eg hip replacement or TURP) Back one slide
Return to start
Exit
Frequently asked questions What is a routine test? A routine test is one that would be carried out for all similar patients undergoing similar operations. They may or may not be the only tests carried out but this would depend on the individual patient.
How long are tests valid for? There is no hard and fast rule for this but in general, for fit patients or those with stable medical conditions blood tests do not need to be repeated within three months. If there has been a significant change in their health then they should have the relevant tests repeated up to one month before surgery.
How long is a Group & Save valid for? Blood can only be issued within 5 days of the most recent Group & save. Most patients in whom this is indicated will therefore need this test repeated on admission.
What is the definition of cardiovascular or renal disease? For the purposes of these guidelines cardiovascular disease means any condition primarily involving the cardiovascular system (e.g. hypertension, angina). Includes suspected disease without formal verification. Renal disease refers to known renal insufficiency or serum creatinine above upper limit of normal with or without dialysis.
More
Back one screen
Back to start
Exit
Frequently asked questions (2) How do I find surgery severity on HISS? 1. PCI > View patient on theatre list
2.
PCI > Theatre Management > View Theatre Profile
Back one screen
Exit
List of procedures ENT / Facio-Maxillary General Surgery (inc Vascular) Gynaecology Ophthalmology Orthopaedics Urology To return to guidance click below for:
<60
60-80
>80
Return to start
List of procedures – ENT Minor
Intermediate
Major/Major +
Laryngoscopy / microlaryngoscopy
ORIF mandible/zygoma
Parotidectomy
Panendoscopy
Neck dissection
UVPP
Mastoidectomy
Branchial cyst excision
Bicoronal flap
Septoplasty
Bimaxillary osteotomy
SMR
Stapedectomy
Reduction fractured nose
Endoscopic sinus surgery
Tympanoplasty
Submucous diathermy(SMD)
Nasal polypectomy
Rhino/ Septorhinoplasty
Pinnaplasty
Laryngectomy
Dental extraction Tonsills/ Adenoids Lymph node biopsy Myringotomy with grommet
Palatoplasty
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Gynaecology Minor
Intermediate
Major / Major +
Hysteroscopy / D&C
Thermal endometrial ablation
Hysterectomy (all types) Vaginal repair
Diagnostic laparoscopy Biopsy / excision / diathermy vulval lesions
Laparoscopic sterilisation
Biopsy / loop excision cervix
Lap and dye
Insert / remove IUCD
Anterior colporrhaphy
Reversal sterilisation Salpingectomt Myomectomy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - General / Vascular Surgery Minor
Intermediate
Major / Major +
EUA rectum
Inguinal hernia repair (inc laparoscopic)
Aortic aneurysm repair
Vasectomy Removal skin lesion
Bowel resection
Femoral or umbilical hernia repair
Closure of ileostomy
Haemorrhoidectomy
Fem-popliteal bypass
Insert Tenckoff catheter
Laparoscopic cholecystectomy
Diagnostic laparoscopy Lymph node biopsy
Laparoscopic Nissen’s fundoplication
Removal gastric balloon
Mastectomy
Orchidopexy
Thyroidectomy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Ophthalmology Minor
Intermediate
Blepharoplasty
Major / Major +
Brow lift
Cornel graft
Cryo to lid
DCR
Enucleation
Entropion
Keratectomy
Medial canthal sling
Excision lid/skin lesion
Lamellar graft
Vitrectomy
Lateral tarsal sling
Ptosis correction
Tarsorraphy
Squint (adult)
Temporal artery biopsy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Orthopaedics Minor
Intermediate
Adjust / remove external fixator
Achilles tendon release
Botox injections
Arthroscopic meniscectomy knee
Carpal tunnel release
Diagnostic arthroscopy (all)
Major / Major + ACL repair Acromioplasty Joint replacement (primary or revision, all joints) Pelvic osteotomy
Excision ganglion Injection / MUA joint Removal K-wires
Excision radial head Metatarsal osteotomy
Removal metalware hip Spinal decompression / fusion
Remove metalware foot/ knee/ Sub-talar fusion arm/ shoulder
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Back one screen
List of procedures - Urology Minor
Intermediate
Major / Major +
Bladder neck incision
Botox injection to bladder
Cystectomy
Cystoscopy
Insertion penile prosthesis
Nephrectomy
Insertion supra-pubic catheter
Orchidectomy
Lithotripsy ureteric stone
Ilial conduit Open prostatectomy TURT/TURP
Prostatic massage Ureteric stent Urethral dilatation Vasectomy
This is a sample only. Specific procedure severities can be found on HISS.
Return to:
<60
60-80
>80
Exit
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