Is routine preoperative crossmatch appropriate for elective laparoscopic cholecystectomy?

Abstract

Background : Inappropriate cross-matching results in a costly waste of resources. A 12-month
report from our blood bank demonstrated an inappropriate use of preoperative blood order with the crossmatch to transfusion (C/T) ratio of 2.08.

Objective : The aim of this study was to assess the cost effectiveness of routine preoperative blood order for elective laparoscopic cholecystectomy.The results will be evidence to implement to ourhospital blood order guideline.

Methods: All elective laparoscopic cholecystectomy cases performed in our institution between January and December 2011 were retrospectively reviewed. With the use of electronic databases of our hospital, open cholecystectomy and cholecystectomy secondary to other procedure were excluded. Preoperative blood order and blood transfusion intraoperative and
within 24 hours postoperatively were identified from medical and anesthetic records. Crossmatch to transfusion (C/T) ratio and blood usage parameters (transfusion probability; %T and transfusion index; Ti) were calculated.

Results: A total of 254 patients
were identified. Of these 242 unit of PRC had been ordered (crossmatch) preoperatively for 233 patients (91.7%). Twenty-one patients had no order for blood preparation. Only one unit of PRC was given in 24 hours postoperatively for a thalassemia patient. The total expense for blood preparation was 65,340 Thai baht while the expense for 1 unit given was 270 Thai baht. Crossmatch to transfusion (C/T) ratio was 242; transfusion probability (%T) and transfusion index (Ti) were 0.43 and 0.0041 respectively. Maximal Surgical blood Order Schedule (MSBOS) was 0.062.

Conclusion: This study reveals excessive blood ordering for elective laparoscopic cholecystectomy. Routine crossmatch is not necessary for this type of operation.