The study
UK researchers conducted a systematic review of research into pre-operative assessments relating to 2003 NICE guidelines. Six papers looking at the clinical effectiveness of pre-operative fasting blood glucose, electrolytes and renal function, and pulmonary function were found. All participants were adult patients undergoing elective minor or intermediate surgery. A large data set that recorded the results of these tests was also obtained from Leeds Teaching Hospitals NHS Trust to assess any link with routine testing and surgical outcomes.
The findings
The literature produced no conclusive evidence on the clinical effectiveness of these tests. For instance, only one study assessed the routine use of pulmonary function tests, and found that only three out of 1,010 patients had pulmonary function assessed, and in all cases the history suggested an abnormality in this area. The proportion of patients with an abnormal pre-operative fasting blood glucose result ranged from 0.8% to 3%, and that the range was even lower for patients with both an abnormal result and a subsequent change in management at 0% to 1.9%.
What does it mean for GPs?
The authors concluded that it is ‘clear that there is not a robust evidence base to support the use of these tests in low-risk patients,’ adding that survey results from Leeds Teaching Hospitals NHS Trust l suggested that clinical practice has moved forward, with universal utilisation of pre-operative tests no longer in force.
Health Technology Assessment 2013, online 16 January
