In Shape for Surgery

Poorly controlled chronic disease, raised BMI, smoking and anaemia can adversely affect the:

  • Outcomes of surgery
  • Risks of complications during and after the operation
  • Length of time spent in hospital
  • Patient's recovery time
  • NHS costs, resources and health professional time needed to care for the patient in hospital and following discharge.


Make Every Contact Count

Identifying and optimising these risk factors prior to surgery will lead to better outcomes.


Surgical Risk Factors Requiring Intervention

  • HbA1c greater than 69mmol/mol
    • An up to date HbA1c is recommended for patients with, and at risk of, Diabetes and Prediabetes
  • Blood pressure greater than 160/100mmHg
  • Smoking
  • BMI > 40
  • Atrial fibrillation rate greater than 100 beats per minute
  • Check for new heart murmurs and organise Echocardiogram and ECG if found
  • Haemoglobin less than 130g/L




Advise patients to stop smoking for at least 8 weeks prior to their operation and ideally long term

Initiate Nicotine Replacement in Primary Care and refer to Healthy Cornwall Smoking Cessation for ongoing support.  Contact us - Healthy Cornwall Patient self referral



NICE recommend the combination of behavioural support and licenced smoking cessation medication is most effective.  If e-cigarettes are chosen for smoking cessation through personal choice, or due to other measures being unsuccessful, still refer to the smoking cessation clinic for support.  

The risk of EVALI (E-cigarette or Vaping Associated Lung Injury) is still unknown.

Patients who do not wish to attempt to stop smoking, despite an informed discussion with their clinicians about the risks involved will still be allowed to proceed to surgery.


Raised BMI

NHS Digital Weight Management GP Referral for patients BMI > 30 (or BMI > 27.5 from Black, Asian and ethnic minority backgrounds) with Hypertension or Diabetes

GP Referral templates can be found here (need practice ONS codes to access) Home Page - NHS Digital Weight Management Programme Template Site (wmp.nhs.uk)

Patient leaflet digital-weight-management-patient-leaflet-a4-folded.pdf (england.nhs.uk)

Better Health - NHS (www.nhs.uk)

Contact us - Healthy CornwallPatient self referral


Keeping Active!

Better Health - NHS (www.nhs.uk)

Contact us - Healthy Cornwall Patient self referral for exercise advice


If Osteoarthritis limits mobility:

OVERVIEW / ESCAPE-pain Online Free NHS programme online 2 sessions/week for 6 weeks

Let's Move with Leon | Versus Arthritis Free online 30 min videos for 12 weeks

Move More - (icareimove.com)   GP/FCP Referral via form, contact info@icareimove.comOnline 25 week programme for patients who are at risk of falls, must be medically stable especially no unstable cardiac/respiratory symptoms under investigation.  Need to be able to stand up independently from a chair.  Some laptops available to loan for Move More programme.



Early investigation into cause and correctable deficiencies treated

Please follow RMS Anaemia Guidelines

Treat to achieve Hb 130g/L

If maximal treatment in Primary Care and Hb < 130 then refer to Blood Management Service



Dr Rebecca Hopkins, GP Orthopaedic Guidelines Lead, Kernow Referral Management Service

Dr Bridgitte Wesson, GP Haematology Guidelines Lead, Kernow Referral Management Service

Dr Will Jewell, Consultant Anaesthetist, Royal Cornwall Hospitals NHS Trust


  1. Alamanda VK, Springer BD.  The Prevention Of Infection: 12 Modifiable Risk Factors.  Bone Joint J 2019 Jan; 101-B1 (1 Supple A):3-9
  2. Lengeurran E et al.  Risk Factors Associated With Revision For Prosthetic Joint Infection Following Knee Replacement: An Observational Cohort Study From England And Wales.  The Lancet 01 2019 Jun; 19, 6, 589-600
  3. Joint British Diabetes Societies For Inpatient Care.  Management Of Adults With Diabetes Undergoing Surgery And Elective Procedures.  Improving Standards; March 2016.
  4. Munoz M et al.  International Consensus Statement On The Peri-operative Management Of Anaemia And Iron Deficiency.  Anaesthesia; 2017, 72, 233-247
  5. Centre For Peri-Operative Care.  Impact Of Peri-operative Care On Healthcare Resource Use; June 2020
  6. Royal Cornwall Hospitals NHS Trust.  Pre Assessment Clinical Guidelines v6.0; Nov 2018.
  7. Cornwall Council.  Health Cornwall, 2019 Contact us - Healthy Cornwall
  8. NHS.  Better Health Better Health - NHS (www.nhs.uk)
  9. NHS England.  NHS Digital Weight Management Programme, 2021.  NHS England » The NHS Digital Weight Management Programme
  10. Orthopaedic Research UK.  Escape Pain Online, 15 August 2021 OVERVIEW / ESCAPE-pain Online]
  11. Versus Arthritis.  Let’s Move With Leon, 2021  Let's Move with Leon | Versus Arthritis
  12. iCareiMove.  Move More Programme, Move More - (icareimove.com)
  13. National Institute of Clinical Evidence. Smoking Cessation, Updated September 2021



Review Date                            18/02/2022

Date of Next Review                18/02/2023

Author                                      Dr. R. Hopkins