TPW 9.02 Routine Preoperative Investigations in Low-Risk Elective Inguinal Hernia Patients: A Closed-Loop Audit
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ID: 323884
2026
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Abstract
Abstract Background NICE recommends specific preoperative investigations which should or should not be performed routinely in adult patients undergoing elective inguinal hernia repair, depending on their ASA grades and comorbidities. This two-cycle audit aimed to evaluate the routine investigations performed in ASA 1 and 2 adult patients prior to their elective inguinal hernia repair at a large tertiary centre. Methods A retrospective analysis was conducted on 200 elective inguinal hernia patients between September 2023 and March 2024. The results were presented at a local meeting, and interventions were subsequently implemented including updated trust guidance and a digital decision-aid tool. To evaluate the impact of these changes, 96 patients were retrospectively analysed between December 2024 and June 2025. This was limited to one of the two hospitals within the trust, where interventions were first implemented. Results The first cycle showed poor overall compliance with NICE guidelines, but the second cycle demonstrated a marked improvement. Among ASA 1 patients, unnecessary preoperative tests decreased by 20.5% for FBC, 21.4% for haemostasis, 22.6% for U&E and 33.0% for ECG. In ASA 2, reductions were 75.0% for FBC, 16.7% for haemostasis, 11.9% for U&E and 9.4% for ECG. No lung function tests or ABG were performed in either cycle. Conclusion The updated trust guidance and digital decision-aid tool were effective in improving compliance with national standards. Further improvements can be achieved by wider implementation across the trust and continued re-auditing. Additionally, the audit can be expanded to assess financial and environmental impact.
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openalex_W7172489154
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| Authors | Tisha Wong, Kamran Khatri, Edward Pugh |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.403
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| Keywords | Keywords not found |
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