Optimization of Preoperative Routine Cross-Matching for Elective Cardiothoracic Surgery in a University Hospital
Keywords:
cardiovascular and thoracic surgery, cross-match to transfusion ratio, routine blood cross-matchingAbstract
Background: Blood transfusion plays a major role in the resuscitation and management of blood loss in surgical patients, especially cardiothoracic surgery. However, excessive blood cross-matching may be a common problem.
Objectives: To evaluate the efficiency of routine preoperative blood ordering and transfusion practices for patients undergoing elective cardiothoracic surgery.
Methods: This is a retrospective descriptive study. Preoperative blood ordering, intraoperative and postoperative blood transfusion within 24 hours postoperatively were recorded from elective cardiothoracic surgery at Srinagarind Hospital and Queen Sirikit Heart Center of the Northeast, Khon Kaen University during a one-year period (January to December 2014). The optimal blood ordering was calculated by cross-match to transfusion ratio (C/T ratio), Transfusion probability (%T) and Transfusion index (Ti).
Results: During the study period, the total of 792 patients were enrolled. Most patients (791 cases) had preoperative red cells cross-matching, but only 650 (82.17%) received red cells transfusion on the day of the operation. The total of 4,055 units of red cells was prepared, but only 2,336 units (57.61%) of red cells were used. The C/T ratio, %T and Ti index in all operations were 1.73, 81.17 and 2.95, respectively that indicated an appropriate use of blood. Classified by type of operations, only the open heart surgery and open aneurysmorraphy were appropriated use of blood(The C/T ratio was 1.58 and 2.06, respectively). While the closed heart surgery, thoracic surgery and endovascular procedure were over blood-ordering (The C/T ratio was 8.67, 12.68 and 3.63, respectively). The cost of preparing blood in those operations in this study was 1,054,300 baht, and the cost of preparing non- transfused blood was wasted 447,460 baht.
Conclusions: The overall preoperative blood cross-matching for elective cardiothoracic surgery was appropriated. However, the closed heart surgery, thoracic surgery and endovascular procedure were over blood-ordering that meant to not appropriate use of blood. The introduction of maximum surgical blood-order schedule from these results will lead to a reduction of unnecessary demand and cross match workload.
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