Background: Pre-operative investigations are often required to supplement information for riskrnstratification and assessing reserve for undergoing surgery. Although there are evidence-basedrnrecommendations for which investigations should be done, clinical practice varies. There are nornclear guidelines regarding preoperative investigations in Tikur Anbesa specialized hospital. Thernpresent study aimed to assess the practice of the pre-operative investigations and compare it withrnthe NICE guideline. rnMethods: Institution based analytic cross-sectional study design was conducted from May tornJuly, 2021. The present study was carried out in TASH after the approval from department ofrnanesthesiology critical care and pain medicine. Data Collected from complete PAC sheets,rninvestigations already done, asked by surgeon/surgery resident, anesthesiologists/ACCPMrnresident and anesthetist were noted and compared with standard recommendations and guidelinern(NICE guideline). Data was coded and entered to SPSS version-25 software. Univariet data wasrnexpresses in frequency, mean, SD and bivariate data was analyzed using fishersâ€™ exact test,rnbinary and multiple logistic regression. P value less than 0.05 was considered staticallyrnsignificant. rnResults: Two hundred nineteen (99.5%) questionnaires were collected and analyzed. Twornhundred sixty-five (31.3%) tests were not indicated as per the NICE guideline. ACCPMrnphysicians are more rational in ordering preoperative investigations as compared tornsurgeons/surgical residents and anesthetists. rnConclusion: Unnecessary preoperative investigations are prevalent at Tikur Anbesa specializedrnhospital. Anesthesiology, critical care and pain medicine physicians are more compliant with thernrecommendation/NICE guideline as compared to surgeons/surgical residents and anesthetists.