23/06/2025
566 Do Elective Inguinal Hernia Patients (ASA 1 & 2) Need Routine Pre-Operative Investigations? Free
T Wong , M Shaukat , K Khatri
British Journal of Surgery, Volume 112, Issue Supplement_10, June 2025, znaf128.145, https://doi.org/10.1093/bjs/znaf128.145
Published: 19 June 2025
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Abstract
Background
NICE recommends that we do not routinely perform preoperative investigations in adult patients undergoing elective inguinal hernia repair, depending on their ASA grades and comorbidities. This audit aims to analyse the routine investigations performed in ASA 1 & 2 patients before their elective inguinal hernia repair at NUTH NHS Foundation Trust.
Method
We retrospectively analysed 200 patients (over 16 years) who underwent primary inguinal hernia repair between September 2023 to March 2024 at NUTH NHS Foundation Trust. The variables include ASA grades, preoperative tests (FBC, haemostasis, U&E, ECG and lung function/ABG), and presence of AKI risk factors and cardiorenal comorbidities.
Results
Amongst ASA 1 patients (23.5%), most had U&E (85.1%), FBC (83%), and ECG (83%). Fewer had haemostasis (27.7%), and none had lung function/ABG.
In ASA 2 (49.5%), FBC and U&E were both performed in 92.9%, ECG in 91.9%, haemostasis in 21.2% and none had lung function/ABG. Of these, 39.4% of renal function and ECG, and 19.2% of haemostasis were not indicated.
Conclusions
Overuse of costly and unnecessary perioperative investigations in generally healthy patients can lead to false positive results, unnecessary treatments, potential surgery delays and increased patient anxiety, all without really changing perioperative status. Updated trust guidelines reflecting NG45 have been developed, with plans to re-audit following implementation.
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