ÖGARI pre-operative laboratory tests (Austrian guideline 2026)

Q: Which pre-operative blood tests does a healthy patient need in Austria?

Under the ÖGARI 2026 guideline, an ASA 1 patient before a small procedure needs none; before a large procedure a blood count, plus fasting glucose/HbA1c for vascular or orthopaedic surgery.

Q: Is a routine coagulation screen needed before surgery?

No. ÖGARI recommends a standardised bleeding history instead; aPTT/PT are reserved for specific indications such as vitamin K antagonists, liver disease or planned intraoperative heparin.

Q: When are troponin and NT-proBNP measured before surgery?

Table 1 lists them for large procedures in ASA 3–4 patients; the text recommends NT-proBNP before large procedures with increased cardiovascular risk (1B) and advises against both before small procedures (1C).

Q: Is the ÖGARI guideline binding in Austria?

It is the medical source guideline of the federal quality guideline BQLL PRÄOP, which is recommended for Austria-wide use; individual clinical judgement remains allowed.

Which pre-operative blood tests the Austrian ÖGARI guideline recommends by ASA class and surgical category

ÖGARI guideline pre-operative evaluation 2026
Source guideline of the Austrian BQLL PRÄOP

Sources last checked: 2026-10-13

ÖGARI pre-operative laboratory tests (Austrian guideline 2026)

Which pre-operative blood tests the Austrian ÖGARI guideline recommends by ASA class and surgical category

Patient category (history and clinical examination)

Surgical category

Known diabetes mellitusVascular surgery or orthopaedic/trauma surgery

Fill in every field to see the result.

For adults before elective surgery in general or regional anaesthesia (not cardiac surgery, transplantation or local anaesthesia). Tests are indicated only after a structured history and examination; an abnormal or impossible history (e.g. language barrier) or abnormal findings justify further tests. Additional indications from Table 1: thyroid tests with clinical signs; anaemia work-up if Hb < 12 g/dL (women) / < 13 g/dL (men); blood gas analysis to consider in COPD ≥ GOLD 3 and/or BMI ≥ 40; targeted coagulation tests after an abnormal standardised bleeding history (ÖGARI form); pregnancy test if pregnancy is suspected. The guideline explicitly allows ordering further tests when clinically indicated.

Source: ARGE präoperatives und tagesklinisches Patientenmanagement der ÖGARI (Duma A et al.). Österreichische Leitlinie zur präoperativen Evaluierung von erwachsenen Patientinnen und Patienten — Update 2026. Section 2.3 and Table 1 (Labordiagnostik), pp. 33-34.Open

Interpretation

ASA 1, small procedure — no laboratory tests	Table 1: blood count, renal function, electrolytes, CRP, coagulation/liver and glucose/HbA1c are all marked 'do not perform'.
ASA 1, large procedure — blood count	Table 1 marks as 'perform': blood count. Marked 'depending on perioperative risk, management and local factors': renal function, electrolytes, CRP, coagulation and liver tests.
ASA 1, large vascular/orthopaedic procedure — blood count + fasting glucose/HbA1c	Table 1 marks as 'perform': blood count and fasting glucose/HbA1c (vascular and orthopaedic/trauma surgery; text p. 30: also with known diabetes, 1B). Marked 'depending on risk': renal function, electrolytes, CRP, coagulation and liver tests.
ASA 2, small procedure — no routine laboratory tests	Table 1 marks as 'do not perform': blood count, renal function, electrolytes, CRP, coagulation/liver. Fasting glucose/HbA1c is marked 'depending on risk'; with known diabetes the guideline text recommends fasting glucose and HbA1c (p. 30, 1B).
ASA 2, large procedure — blood count, renal function, electrolytes	Table 1 marks as 'perform': blood count, renal function (eGFR, creatinine, BUN), electrolytes (Na, K); as 'do not perform': CRP; as 'depending on risk': coagulation and liver tests.
ASA 2, large procedure with diabetes or vascular/orthopaedic surgery — plus fasting glucose/HbA1c	Table 1 marks as 'perform': blood count, renal function, electrolytes, fasting glucose and HbA1c; as 'do not perform': CRP; as 'depending on risk': coagulation and liver tests.
ASA 3, small procedure — tests only depending on risk	Table 1 marks as 'do not perform': blood count; as 'depending on perioperative risk, management and local factors': renal function, electrolytes, CRP, coagulation/liver, glucose/HbA1c. With known diabetes the guideline text recommends fasting glucose and HbA1c (p. 30, 1B).
ASA 3, large procedure — blood count, renal function, electrolytes, CRP	Table 1 marks as 'perform': blood count, renal function, electrolytes, CRP; as 'depending on risk': coagulation and liver tests. Large procedure with ASA 3–4: cardiac troponin and NT-proBNP are listed in Table 1.
ASA 3, large procedure with diabetes or vascular/orthopaedic surgery — plus fasting glucose/HbA1c	Table 1 marks as 'perform': blood count, renal function, electrolytes, CRP, fasting glucose and HbA1c; as 'depending on risk': coagulation and liver tests. Large procedure with ASA 3–4: cardiac troponin and NT-proBNP are listed in Table 1.
ASA 4 — individual interdisciplinary decision; full panel	Table 1 marks all groups as 'perform' (blood count, renal function, electrolytes, CRP, coagulation and liver, glucose/HbA1c) within an individual interdisciplinary decision. Large procedure: cardiac troponin and NT-proBNP are listed.

What is the ÖGARI pre-operative laboratory tests (Austrian guideline 2026)?

This tool applies Table 1 (laboratory diagnostics) of the Austrian guideline on pre-operative evaluation of adults, Update 2026, by the ÖGARI working group on pre-operative and day-case patient management. The guideline was updated from the 2011 ÖGARI source guideline with a systematic literature search (308 publications) and a Delphi consensus, and it is the medical source guideline of the Austrian federal quality guideline BQLL PRÄOP. It links blood tests to the ASA class (as defined by history and examination) and to a two-tier small/large surgical category.

When to use it

Planning pre-operative blood tests for adults before elective surgery in general or regional anaesthesia.
Pre-anaesthesia clinics and referring GPs in Austria aligning with the BQLL PRÄOP.
Avoiding low-value routine testing in healthy patients before small procedures.

When not to use it

Emergency or urgent surgery, cardiac surgery, organ transplantation or procedures in local anaesthesia (outside the guideline's scope).
Children (ÖGARI has a separate paediatric recommendation).
As a substitute for history and examination — the table assumes both have been done.

How it is calculated

ÖGARI 2026, Table 1: ASA 1–4 × small/large procedure → blood count, renal function, electrolytes, CRP, coagulation & liver, fasting glucose/HbA1c (perform / depending on risk / do not perform)

Clinical pearls and limitations

For adults before elective surgery in general or regional anaesthesia (not cardiac surgery, transplantation or local anaesthesia). Tests are indicated only after a structured history and examination; an abnormal or impossible history (e.g. language barrier) or abnormal findings justify further tests. Additional indications from Table 1: thyroid tests with clinical signs; anaemia work-up if Hb < 12 g/dL (women) / < 13 g/dL (men); blood gas analysis to consider in COPD ≥ GOLD 3 and/or BMI ≥ 40; targeted coagulation tests after an abnormal standardised bleeding history (ÖGARI form); pregnancy test if pregnancy is suspected. The guideline explicitly allows ordering further tests when clinically indicated.
Surgical category is two-tier: small vs large, judged by expected blood loss (≥ 10 % of blood volume), technique, region and duration.
Routine global coagulation tests (aPTT, PT) are not recommended in asymptomatic patients; a standardised bleeding history comes first (1B).
Fasting glucose and HbA1c: with known diabetes and before large vascular or orthopaedic procedures (1B each).
Pre-operative tests are not population screening in Austria — 'detecting undiagnosed diabetes' is not an indication.
Clinicians may always order further tests when individually indicated; the table guides the average patient.

Frequently asked questions

Which pre-operative blood tests does a healthy patient need in Austria?

Under the ÖGARI 2026 guideline, an ASA 1 patient before a small procedure needs none; before a large procedure a blood count, plus fasting glucose/HbA1c for vascular or orthopaedic surgery.

Is a routine coagulation screen needed before surgery?

No. ÖGARI recommends a standardised bleeding history instead; aPTT/PT are reserved for specific indications such as vitamin K antagonists, liver disease or planned intraoperative heparin.

When are troponin and NT-proBNP measured before surgery?

Table 1 lists them for large procedures in ASA 3–4 patients; the text recommends NT-proBNP before large procedures with increased cardiovascular risk (1B) and advises against both before small procedures (1C).

Is the ÖGARI guideline binding in Austria?

It is the medical source guideline of the federal quality guideline BQLL PRÄOP, which is recommended for Austria-wide use; individual clinical judgement remains allowed.

Evidence and guidelines

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