Routine pre-operative tests and blood pressure

These are two guidelines, but both on the topic of pre-operative testing, so they fit nicely together. I am just pulling out the points useful for us GPs.

Pre-operative tests

This is a new guideline from NICE on what tests are required pre-operatively. Most of it is obviously for secondary care, but there are a couple of useful points for us.

  • HbA1c - diabetic patients should have their latest value added into their referral letter. They need a result within 3m of surgery.
  • Minor Surgery - this includes removal of skin lesions under local anaesthetic. In patients who are ASA 3 or 4 (see the link below), consider doing U+E if they are at risk of Acute Kidney Injury, and an ECG if one hasn't been done in the last 12 months. There is a useful linked document which summarises what tests should be done and when, which may be useful to look at if you do any procedures in surgery.

Pre-operative blood pressures

This is a new guideline from the British Hypertension Society, which is excellent and should save some of those pesky requests coming back from pre-op clinics for us to start anti-hypertensives.

Target BP of 160/100 - patients undergoing surgery should be known to have a blood pressure in general practice of 160/100 or less. Ensure this is achieved before referral and state it in the referral letter. This will avoid them having to measure it in pre-op clinic and then getting spurious high levels. This should avoid us having to either start, or titrate up medication inappropriately. They are very clear that diagnosis of blood pressure should be done in general practice and we should carry out our normal procedures for diagnosis if a high reading is found pre-op.

Maximum BP of 180/110 - if there is no documented BP within the last 12m, patients should have it done in pre-op clinic and can proceed to surgery if it is below the rather stonking 180/110.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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