Evaluation of the use of blood in surgeries as a tool to change patterns for requesting blood product reserves

Abstract

OBJECTIVES: Thirty to sixty percent of prepared blood products are not transfused. Blood reserves for surgeries lead to many unused blood products, which increases hospital costs. The aim of this study is to identify the request and use profiles of blood products for elective surgeries in different surgical specialties, the influence of surgery time and demographic, clinical, and laboratory variables on the number of red blood cells (RBCs) used and to calculate the rate of transfused patients (RTP) and cross-matched and transfused (C/T) RBCs. METHODS: Observational and prospective studies. Sociodemographic, clinical and quantitative data on the request and use of blood products were collected. The influence of the data on the use of RBCs was examined by binary logistic regression. Chi-square, one-way ANOVA and Kruskal-Wallis tests were utilized to compare the data among the specialties. RESULTS: In total, 822 procedures were included. Most of the requested blood products were not used, even 24 hours postoperatively. Of the 2,483 RBC units, 314 were transfused, leaving 87.6% unused; however, cardiac, digestive tract, vascular, gynecologic, urologic and thoracic surgery procedures transfused 50%, 25%, 16.5%, 11%, 9.5% and 8.1% of requested RBCs, respectively. The factors that influenced the transfusions were age, time of surgery and cardiac surgeries. The RTP was >10% in 22 surgical types and <1% in 24 surgical types, and 88% of samples presented a C/T ratio >2.5. CONCLUSION: The RTP and C/T ratios can guide RBC requests in the preoperative period. Knowing the standard of use of blood products and developing protocols enables the optimization of reserves, reduction of costs and improvement of care.

Is routine blood typing and screening necessary for degenerative cervical spine surgery patients in specialty surgical hospitals?

“…Screening tests are usually ordered as a prophylactic measure, even if no indication is present for serologic type and screen tests. 9,10 In our study, the overall reported risk of undergoing a transfusion in the postoperative period after an elective cervical spine surgery was 1.9%. As literature report, one of the reasons for blood wastage is preoperative excessive cross-matching.…”

“…Diagnostic tests are ordered for symptomatic patients to assess severity of symptoms and determine a treatment regimen. Screening tests are usually ordered as a prophylactic measure, even if no indication is present for serologic type and screen tests 9,10 . In our study, the overall reported risk of undergoing a transfusion in the postoperative period after an elective cervical spine surgery was 1.9%.…”

“…Today's healthcare climate is rapidly transitioning toward value‐based bundled payment models that reward quality and efficiency 8 . Despite a large amount of blood being donated free, the processing of blood after donation and the amount of work that goes into the process make the blood so expensive, thereby it is important to warrant an effective utilization of this lifesaving liquid 9 . There is limitation of blood as a resource because they are no infinite 4 .…”

“…8 Despite a large amount of blood being donated free, the processing of blood after donation and the amount of work that goes into the process make the blood so expensive, thereby it is important to warrant an effective utilization of this lifesaving liquid. 9 There is limitation of blood as a resource because they are no infinite. 4 We hypothesized that all patients who underwent cervical spine surgery for degenerative pathology do not need a pretransfusion testing.…”

Analysis of requests for reservation of blood concentrates in patients referred to urgent surgeries in a teaching hospital

“…A ratio lower than or equal to 2.5 is considered an indication of efficient use of blood 8 . Also, the probability of transfusion (PT), defined as the number of transfused patients divided by the number of typed patients (x100), and the transfusion index (TI), considered as the number of transfused units divided by the number of typed patients (values > 0.5 are considered effective use of blood) 8,9 , were calculated.…”