Pre-operative routine cross-match for elective thyroid surgery: an appropriate use of blood utility

Abstract

Background: Surgical procedures frequently require blood transfusion. Blood and its components are frequently ordered and cross-matched excessively, without proper analysis of the real needs.

Objective: The purpose of this study was to analyses the actual intraoperative requirement versus the ordering of blood in elective thyroid surgery before implementation of a blood order guideline.

Methods: Consecutively elective thyroid surgeries from January to December 2011 were collected retrospectively using an electronic management information system of Srinagarind
Hospital and anesthetic records. Pre-operative cross-match status and blood transfusion data for each patient were identified from the medical and anesthetic records. The blood utilization parameters include cross-match to transfusion (C/T) ratio; transfusion probability (%T) and transfusion index (Ti) were calculated.

Results: There were 257 patients undergone thyroid surgery. 73 units of pack red blood
cell were prepared for 114 cases. Only 11 units of the prepared blood were used for the 5 patients. The total cost for the blood preparation was 30,780 baht, while the expense of the actual blood used only 2,970 baht. The transfusion utilization indices, C/T ratio, % T and Ti, were 10.36, 6.84 and 0.096, respectively.

Conclusion: This study shows the over-ordering blood by routine pre-operative cross-match for elective thyroid surgery. Blood should be typed and screened preoperatively and cross-matched only when clinically indicated to minimize inappropriate request and expenditure.