Anna Brodska
Tests Before Plastic Surgery
Preoperative tests are not a box-ticking exercise or a search for every possible disease. They identify factors that may change anaesthesia, bleeding, infection, clot or healing risk. The list depends on health, procedure and anaesthetic—not a universal package.
I first take the history and medication list, then interpret results with the anaesthetist. Normal numbers never replace disclosure of breathlessness, fainting, allergy, previous complications or family thrombosis.
Do not order a random “maximum panel” or hide abnormalities. A result without context may trigger unnecessary investigation, while missing history creates real risk.
Core groups and purpose
| Group | What it may assess | Possible impact |
|---|---|---|
| Full blood count | Haemoglobin, white cells, platelets | Anaemia, possible infection or platelet-number issue |
| Kidney function / electrolytes | Creatinine/eGFR, sodium, potassium | Medicines, fluids, optimisation or further review |
| Glucose / HbA1c | Current and longer-term glucose control | Diabetes optimisation and infection/healing risk |
| Haemostasis | Selected clotting pathways when indicated | Planning with liver disease, bleeding or anticoagulants |
| Blood group / compatibility | Need depends on procedure and local policy | Preparation for justified potential blood loss |
NICE does not recommend every test for every healthy person before minor surgery. Major procedures and comorbidity require broader assessment.
Full blood count
Haemoglobin detects anaemia but not its cause. Heavy periods, iron deficiency, chronic illness and recent bleeding require different action. White cells are not a universal infection test, while platelet count is only one element of haemostasis.
Report:
- heavy or prolonged periods;
- weakness, breathlessness, palpitations or fainting;
- nosebleeds, large bruises or dental bleeding;
- recent fever or infection;
- bariatric surgery, restrictive diets or malabsorption.
Kidneys, electrolytes, liver and glucose
Kidney function affects fluid and drug handling. Electrolytes may change with diuretics, vomiting, severe diets or disease. Liver tests are history-driven and may affect medicines and clot assessment.
For known diabetes, NICE recommends a recent HbA1c; it is not automatically required for everyone without diabetes.
Clotting and medicines
| Situation | Why routine testing may be insufficient | What the team needs |
|---|---|---|
| Warfarin | Has specific laboratory monitoring | Recent result and agreed perioperative plan |
| Direct oral anticoagulant | Routine tests do not reliably measure effect | Name, dose, last intake and kidney function |
| Aspirin / antiplatelet | Effect is not captured by a standard coagulation screen | Indication and specialist plan |
| Bleeding history | Normal screening cannot exclude every disorder | Detailed history and sometimes haematology |
| Liver disease | Several haemostasis pathways may change | Condition-specific testing and risk assessment |
Never stop anticoagulant or cardiology medication yourself.
ECG, lungs and imaging
An ECG records cardiac electrical activity; it is not a certificate of a healthy heart. Need depends on age, procedure magnitude, cardiovascular, renal and metabolic disease and symptoms. Echocardiography, chest X-ray and lung tests are not routine without reason.
Report new:
- chest pain or pressure;
- breathlessness at rest or usual exertion;
- fainting or near-fainting;
- irregular heartbeat;
- major loss of exercise tolerance;
- leg swelling or breathlessness when lying flat.
Pregnancy and infection
When pregnancy is possible, status is checked with consent under local protocol; cycle dates alone may not be enough. See menstruation and surgery.
Infection testing depends on facility, symptoms and procedure. New fever, cough, rash, infected wound or antibiotics after tests must be reported.
Prepare results correctly
- Obtain the personal list and accepted time window.
- Use a laboratory whose results can be verified.
- Do not alter food, water or medication unless instructed.
- Send the complete report with date, units and reference ranges.
- Add previous results for comparison when relevant.
- Wait for team confirmation; self-reading “normal” is not clearance.
Use the full preoperative checklist and, after major loss, the guide to stable weight and nutrition.
Why a test may be repeated
- the accepted interval has passed;
- symptoms or medicines changed;
- infection, admission or bleeding occurred;
- the result conflicts with history or seems technically unreliable;
- the operation became more extensive;
- response to treatment needs confirmation.
Frequently asked questions
Is there one panel for all plastic surgery?
No. Local protocols exist, but procedure, anaesthesia, age, health and medicines determine the list.
Do normal results guarantee surgery?
No. Examination, symptoms, history, anaesthetic assessment and changes after testing still matter.
Should tumour markers be added “just in case”?
No. They are not a universal preoperative screen; every test needs a clinical reason.
What should I do with a small abnormality?
Do not self-treat a number. Send the full result for contextual interpretation.
Key point
Good assessment means the right questions, justified tests and action on results—not the largest panel. I use testing to modify risk before surgery, not merely file paperwork.
Sources
- NICE: Routine preoperative tests
- NHS: Preparing for surgery
- Royal College of Anaesthetists: Preparing for an operation
Medically reviewed by Anna Brodska, plastic surgeon. Updated 7 September 2026.
