SOURCE: Martin SK, Cifu AS. JAMA 2017;318:567-568.
Many U.S. clinicians may be unfamiliar with the U.K.’s National Institute for Health and Care Excellence (NICE) agency. Since 1999, NICE has been a world-recognized leader in the development of guidelines for management of disorders such as hypertension, dyslipidemia, and other epidemiologically important topics. Recently, NICE provided recommendations about which laboratory tests (if any) might be considered routinely appropriate preoperatively for elective surgery. The rationale for providing this guidance stems from the observation that, historically, there have been an excessive number of pre-op tests performed that not only provide no benefit for patient outcomes, but actually may cause harm because of unnecessary expense as well as need for follow-up of incidental (usually irrelevant) abnormal findings.
For example, recommendations pertinent to “intermediate surgery” (i.e., inguinal hernia repair, tonsillectomy and adenoidectomy, knee arthroscopy) in essentially healthy individuals are to eliminate preoperative testing entirely. Less healthy individuals, such as those with a severe systemic disease (American Society of Anesthesiologists Grade 3 or Grade 4), should undergo pre-op renal function testing only. For patients with symptomatic cardiovascular or renal disease, the guidelines call for a complete blood count. Space limitations preclude a comprehensive review of the full contents of this document, which may be accessed readily online. The authors of the guideline acknowledged a very limited literature from which to draw evidence-based conclusions, and encourage further definitive research on this topic.