Skip to main content Accessibility help
Hostname: page-component-5d59c44645-klj7v Total loading time: 0 Render date: 2024-02-29T22:01:44.996Z Has data issue: false hasContentIssue false

Chapter 31 - Pre-operative investigations

Published online by Cambridge University Press:  05 July 2014

Joseph E. Arrowsmith
Papworth Hospital
Jane Sturgess
Addenbrooke’s Hospital, Cambridge
Justin Davies
Addenbrooke’s Hospital, Cambridge
Kamen Valchanov
Papworth Hospital, Cambridge
Get access



Among the many roles that the anaesthetist has, risk assessment and risk modification are perhaps the most important. In order to manage peri-operative risk, the anaesthetist must have an understanding of the impact of co-existing medical conditions and concomitant drug therapy on normal physiology, and an appreciation of their likely interactions with both anaesthesia and surgery. When conducted effectively, pre-operative assessment decreases the risk of cancellations on the day of surgery and has the potential to reduce peri-operative morbidity and mortality.

Taking a detailed medical history and performing a competent physical examination remain the most efficient and effective ways of predicting and detecting significant co-morbid conditions. Pre-operative investigations should therefore be considered an adjunct to, rather than a substitute for, basic medical vigilance. Many pre-operative clinical investigations are justifiable on the grounds that they aid diagnosis (e.g. CT scan), assist in surgical planning (e.g. coronary angiography), permit more accurate risk stratification (e.g. exercise testing), guide risk-modification strategies or provide a ‘baseline’ before major surgery. A significant number of tests, however, are ordered ‘routinely’ without any clinical indication or justification.

Publisher: Cambridge University Press
Print publication year: 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Chung, F, Mezei, G, Tong, D. Pre-existing medical conditions as predictors of adverse events in day-case surgery. Br J Anaesth 1999; 83(2): 262–70.CrossRefGoogle ScholarPubMed
Johansson, T, Fritsch, G, Flamm, M, et al. Effectiveness of non-cardiac pre-operative testing in non-cardiac elective surgery: a systematic review. Br J Anaesth 2013; 110(6): 926–39.CrossRefGoogle Scholar
Klein, AA, Arrowsmith, JE. Should routine pre-operative testing be abandoned? Anaesthesia 2010; 65(10): 974–6.CrossRefGoogle ScholarPubMed
Priebe, HJ. Cardiovascular disease and non-cardiac surgery. In Mackay, JH, Arrowsmith, JE, eds., Core Topics in Cardiac Anesthesia, 2nd edn. Cambridge: Cambridge University Press, 2012; pp. 469–78.CrossRefGoogle Scholar
Ricci, WM, Della Rocca, GJ, Combs, C, Borrelli, J. The medical and economic impact of pre-operative cardiac testing in elderly patients with hip fractures. Injury 2007; 38 (Suppl. 3): S49–52.CrossRefGoogle Scholar
Smetana, GW, Macpherson, DS. The case against routine pre-operative laboratory testing. Med Clin North Am 2003; 87(1): 7–40.CrossRefGoogle Scholar
Task Force for Pre-operative Cardiac Risk Assessment and Peri-operative Cardiac Management in Non-cardiac Surgery; European Society of Cardiology (ESC), Poldermans, D, Bax, JJ, Boersma, E, et al. Guidelines for pre-operative cardiac risk assessment and peri-operative cardiac management in non-cardiac surgery. Eur Heart J 2009; 30(22): 2769–812.Google Scholar
Valchanov, KP, Steel, A. Pre-operative investigation of the surgical patient. Surgery (Oxford) 2008; 26(9): 363–8.CrossRefGoogle Scholar
Wijeysundera, DN, Beattie, WS, Austin, PC, Hux, JE, Laupacis, A. Non-invasive cardiac stress testing before elective major non-cardiac surgery: population-based cohort study. BMJ 2010; 340: b5526.CrossRefGoogle ScholarPubMed
Working Party of the Association of Anaesthetists of Great Britain and Ireland. AAGBI Safety Guideline. Pre-operative Assessment and Patient Preparation: The Role of the Anaesthetist 2. London: AAGBI, 2010. Available at .Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats