Which preoperative tests should be ordered according to ISA Guidelines

Preoperative tests are critical for the planning, stratification, optimization, and perioperative treatment of surgical patients, as well as for improving patient outcomes. Despite published standards from professional organizations across the world, preoperative investigation techniques are not universal owing to socio-economic, emographic, and medico-legal issues.

The Indian Society of Anaesthesiologists (ISA) attempted to develop practice recommendations for preoperative investigations based on scientific data. The purpose of the recommendations is to encourage the prudent ordering of preoperative examinations, with an emphasis on perioperative treatment techniques. In consideration of regional, demographic, socioeconomic, and medicolegal factors, the recommendations are anticipated to improve patient outcomes.

In some surgical populations, a uniform sequence of investigations is inappropriate. The investigations ordered depend on the nature and urgency of the operation (elective, semi-elective, emergency), the patient's present physiological condition, co-morbidities, and drugs.

Following a three-step Delphi technique, an agreement was reached on the suggestions.

The summary of the final suggestions was given to the Governing Council and General Body of ISA and officially adopted by both bodies.

Recommendation 1: Preoperative complete blood count testing is suggested for patients undergoing minor, intermediate and major surgery.

Recommendation 2a: Preoperative serum creatinine estimation is NOT suggested for patients undergoing minor surgery.

Recommendation 2b: Preoperative serum creatinine estimation is suggested for patients undergoing intermediate and major surgery.

Recommendation 3: Preoperative serum sodium and potassium estimation is NOT suggested for patients undergoing minor, intermediate and major surgery.

Recommendation 4a: Preoperative liver function testing is NOT suggested for patients undergoing minor and intermediate surgery

Recommendation 4b: Preoperative liver function testing is suggested for patients undergoing major surgery

Recommendation 5: Preoperative coagulation profile (PT/INR and aPTT) testing is NOT suggested for patients undergoing minor, intermediate and major surgery

Recommendation 6: In non-diabetic patients, pre operative blood glucose estimation is NOT suggested when scheduled to undergo minor, intermediate and major surgery.

Recommendation 7a: In non-cardiac patients, pre operative 12-lead electrocardiogram testing is suggested at age 45 years and above, when scheduled to undergo minor and intermediate surgery.

Recommendation 7b: Preoperative 12-lead electro cardiogram testing is suggested for all patients undergoing major surgery.

Recommendation 8a: Preoperative chest X-ray testing is NOT suggested for patients undergoing minor surgery.

Recommendation 8b: Preoperative chest X-ray testing is suggested for patients aged 50 years and above, undergoing intermediate and major surgery

Recommendation 9: Routine preoperative ultra sonographic airway assessment is NOT suggested for predicting difficult laryngoscopy.

Recommendation 10a: The acceptable validity time (VTPIN) for a previously performed normal complete blood count, renal function tests, liver function tests, coagulation profile, is suggested to be 2 months provided the clinical condition of the patient has not changed in the intervening period.

Recommendation 10b: The acceptable validity time (VTPIN) for a previously performed normal 12-lead electrocardiogram and chest X-ray, is suggested to be 12 months provided the clinical condition of the patient has not changed in the intervening period.

Reference –

Umesh, Goneppanavar,; Bhaskar, S. Bala1; Harsoor, S. S.2; Dongare, Pradeep A.3; Garg, Rakesh4; Kannan, Sudheesh5; Ali, Zulfiqar6; Nair, Abhijit7; Bhure, Anjali Rakesh8; Grewal, Anju9; Singh, Baljit10; Rao, Durga Prasad11; Divatia, Jigeeshu Vasishtha12; Sinha, Mahesh13; Kumar, Manoj14; Joshi, Muralidhar15; Shastri, Naman16; Malhotra, Naveen17; Saikia, Priyam18; MC, Rajesh19; Das, Sabyasachi20; Ghosh, Santu21; M, Subramanyam22; Tantry, Thrivikrama23; Mangal, Vandana24; Keshavan, Venkatesh H.25 Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists, Indian Journal of Anaesthesia: May 2022 - Volume 66 - Issue 5 - p 319-343

doi: 10.4103/ija.ija_335_22