Preparing for surgery with a pre-operative assessment

What a pre-operative assessment is

A pre-operative assessment is a review of your health before a planned operation, so that risks are known and anything that can be improved is improved in time. Your surgical team and anaesthetist make the final decision about fitness for surgery, and a GP review beforehand helps them by gathering everything they need to know in one place.

NICE advises teams to use a validated tool alongside clinical judgement to estimate the risks of surgery, and to discuss those risks and your options with you [1]. Anaesthetists often describe overall fitness using the ASA grade, from grade 1 for a healthy person to grade 4 for severe illness that is a constant threat to life [2].

Which tests are done, and which are not

Tests depend on the size of the operation and on your health, and a healthy person having minor surgery usually needs no routine blood tests at all [2]. Before major surgery, NICE advises a full blood count for everyone, and kidney function and an ECG for people with any long-term health condition, ASA grade 2 or above [2]. For a healthy person over 65 having major surgery, an ECG is considered if there is none from the past 12 months [2].

Some tests are not offered routinely before surgery, including chest X-rays, urine dipstick tests, resting echocardiograms and HbA1c in people without diabetes [2]. If you have diabetes, NICE advises an HbA1c test if you have not had one in the last 3 months [2]. Fewer tests done for a reason are better than many done by habit, because an unnecessary test can delay surgery for a result that changes nothing.

Your medicines before surgery

Your medicines shape which tests are needed and how the operation is planned [2]. If you take an anticoagulant, the team makes an individual plan for it, and some newer anticoagulants cannot be measured by routine blood tests [2].

NICE advises considering stopping oestrogen-containing contraceptive pills or hormone replacement therapy 4 weeks before planned surgery, to lower the risk of blood clots, with advice on other contraception if the pill is stopped [3]. Make any change only on a doctor’s advice, and tell the team about supplements and herbal remedies too.

What you can do in the weeks before

If you smoke, stopping before surgery helps. A meta-analysis of 6 randomised trials found a 41% relative reduction in complications after surgery among people who stopped, with each extra week of stopping adding to the benefit [4]. A Cochrane review found that intensive support beginning 4 to 8 weeks before surgery, with weekly counselling and nicotine replacement, was most likely to reduce complications [5].

NICE also advises talking about cutting down on alcohol before surgery [1]. On the day itself, follow your hospital’s fasting instructions exactly, and NICE advises that clear fluids such as water are usually allowed until 2 hours before the operation [1].

Who it is not for, and the risks

A GP review prepares you and your records, and the hospital’s own assessment still takes place. It is not suited to emergency surgery, where the hospital team assesses you directly.

The main risk is testing for its own sake. A borderline result in a test that was never needed can lead to further investigation and a postponed operation. If you develop chest pain, sudden breathlessness, a painful swollen leg or confusion before your operation, call 999 in the UK or the local emergency number [6].

A checklist before your operation

Bring these to your pre-operative appointment, and keep copies for the hospital.

• The name of the operation, the hospital and the date
• A full list of your medicines, supplements and herbal remedies, with doses
• Any allergies and past reactions to an anaesthetic, in you or your family
• Recent blood results and ECGs, especially from the past 12 months
• Letters about heart, lung, kidney or diabetes care
• Your plan to stop smoking or cut down on alcohol, if either applies

Questions to ask your doctor

These questions help you arrive at the hospital prepared, with nothing left to chance.

• Which tests do I need for this operation, and which can I skip?
• Which of my medicines should I stop or change, and when?
• Is there anything I can improve in the weeks I have?
• Can you write a summary for my surgeon and anaesthetist?

How The Wellness can help

A GP appointment reviews your history and medicines and arranges only the tests your operation calls for. The doctor can then write a summary for your surgeon and anaesthetist. The Core Wellness blood test includes a full blood count and HbA1c, and every result is explained by a doctor.

Every doctor is GMC registered, and our clinics on Baker Street in Marylebone and Eccleston Street in Belgravia are open from seven in the morning to nine at night every day.