Shaping better health
REMEDY : BNSSG referral pathways

Pre-operative assessment

Checked: 26-02-2018 by Rob.Adams Next Review: 26-02-2019


Many routine operations are cancelled due to modifiable pre-operative conditions including poorly controlled diabetes, poorly controlled hypertension, iron deficiency anaemia and other conditions. Pre- operative optimisation in primary and secondary care can help to reduce cancellations and improve operation outcomes.

For example, with regards to diabetes control, data from NBT anaesthetists indicates that:

  • 288 (21%) patients per annum attending NBT preop have HbA1c > 69
  • Of those with HbA1c > 69 33% had their surgery delayed.
  • When a patient is delayed the mean time of delay is 5mths.
  • The evidence is that HbA1c increases morbidity/joint infections and length of stay.
  • NICE and Diabetic societies have produced guidelines stating that patients with HbA1c > 69 should be delayed if possible.

(See Power Point presentation provided by Simon Lewis (Consultant Anaesthetist and NBT Lead for pre-op assessment for further details.)


Pre-op information in Primary Care

It is increasing important that all referrals (particularly to surgical specialities) should now include the following up to date information (preferably done at time of referral or at minimum within the last 6 months)



HbA1c - if patient has diabetes or is at risk of diabetes. HbA1c should be less than 69 for routine surgery.

FBC, ferritin and UE. Anaemia should be corrected prior to surgery where possible.

Smoking status - stopping smoking prior to surgery can help to improve surgical outcomes.

Addressing these operative risk factors in primary care prior to referral or whilst awaiting first out patient appointment would be hugely beneficial to patients and secondary care colleagues.

A standard referral template is now used in North Somerset practices and is being introduced across BNSSG which will help to standardise the information provided in referrals.