Are Type and Screen Samples Routinely Necessary Before Laparoscopic Cholecystectomy?

Fong, Michelle; Rodriguez, Dan; Elberm, Hassan; Berry, David P.

doi:10.1007/s11605-020-04515-8

Cited by 7 publications

(15 citation statements)

References 18 publications

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“…All the abstracts were screened and 15 full-text articles [11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] strictly met the study inclusion criteria-a total of 477,437 patients. All were retrospective studies: 10 studies [11,19,21,23,[25][26][27][28][29][30] reviewed the necessity of G&S for cholecystectomy procedures only, two studies [31,32] on appendectomy procedures only and three studies [20,22,24] evaluated both procedures. A PRISMA [33] flowchart of the section process for this study is presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…We evaluated the existing published literature on the rate of perioperative blood transfusion and the need for G&S testing prior to cholecystectomy and appendectomy. Our review demonstrates that preoperative G&S testing is being performed nationally and internationally, whether as a Acceptable mandatory policy in many hospitals [23,24,29,32,34], or owing to limited available guidance. We found an extremely low risk of blood transfusion rate of 2.1% across the 15 studies, with only two patients [19] requiring intraoperative emergency transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…Within 30 days of index admission Total: 0 (0.0) Acceptable day-case surgery which does not specifically mention the role of preoperative G&S [36]. Fong et al [23] suggested that the patients that required a blood transfusion were predictable from their preoperative clinical status and risk factors, and therefore a highly selective opt-in policy is safe and would not compromise patient safety. Routinely sending two G&S samples prior to cholecystectomy and appendectomy may be an unnecessary use of resources.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic cholecystectomy was completed in at least 469,338 (98.9%) patients. Ten [11,20,21,23,[25][26][27][28][29][30][31] out of 13 studies recorded the number of patients that underwent preoperative G&S testing. Data was extractable in nine of these studies: a total of 177,178/468,981 (37.8%, range 8.5-100%) patients.…”

Section: Cholecystectomy Proceduresmentioning

confidence: 99%

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Requirement of preoperative blood typing for cholecystectomy and appendectomy: a systematic review

Fadel

Patel

O'Leary

et al. 2022

Langenbecks Arch Surg

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Purpose Blood typing, or group and save (G&S) testing, is commonly performed prior to cholecystectomy and appendectomy in many hospitals. In order to determine whether G&S testing is required prior to these procedures, we set out to evaluate the relevant literature and associated rates of perioperative blood transfusion. Methods Studies from January 1990 to June 2021 assessing the requirement of preoperative G&S testing for elective or emergency cholecystectomy and appendectomy were retrieved from MEDLINE, EMBASE and CINAHL databases. The search was performed on 6th July 2021 (PROSPERO registration number CRD42021267967). Number of patients, co-morbidities, operation performed, number of patients that underwent preoperative G&S testing, perioperative transfusion rates and financial costs were extracted. Results We initially screened 194 studies of which 15 retrospective studies, a total of 477,437 patients, specifically met the inclusion criteria. Ten studies reported on cholecystectomy, two studies on appendectomy and three studies included both procedures. Where reported, a total of 177,539/469,342 (37.8%) patients underwent preoperative G&S testing with a perioperative transfusion rate of 2.1% (range 0.0 to 2.1%). The main preoperative risk factors associated with perioperative blood transfusion identified include cardiovascular co-morbidity, coagulopathy, anaemia and haematological malignancy. All 15 studies concluded that routine G&S is not warranted. Conclusion The current evidence suggests that G&S is not necessarily required for all patients undergoing cholecystectomy or appendectomy. Having a targeted G&S approach would reduce delays in elective and emergency lists, reduce the burden on the blood transfusion service and have financial implications.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Cholecystectomy Proceduresmentioning

confidence: 99%

See 2 more Smart Citations

Requirement of preoperative blood typing for cholecystectomy and appendectomy: a systematic review

Fadel

Patel

O'Leary

et al. 2022

Langenbecks Arch Surg

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“…The requirement for a preoperative T/S has been called into question across a multitude of different surgical specialites. [20][21][22][23][24] Substantial efforts to optimize blood ordering requirements and the MSBOS have also taken place in hospitals nationwide. 1,25,26 The results of this analysis suggest that obtaining routine T/S is not cost-effective for patients undergoing transsphenoidal hypophysectomy, transsphenoidal craniopharyngioma resection, and computer-assisted CSF leak repair when considering nationally representative data on transfusion rates and a wide range of costs and WTP thresholds.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries

Spillinger

Allen

Karabon

et al. 2021

J Neurol Surg B Skull Base

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Objective The study aimed to evaluate the cost-effectiveness of obtaining preoperative type and screens (T/S) for common endonasal skull base procedures, and determine patient and hospital factors associated with receiving blood transfusions. Study Design Retrospective database analysis of the 2006 to 2015 National (nationwide) Inpatient Sample and cost-effectiveness analysis. Main Outcome Measures Multivariate regression analysis was used to identify factors associated with transfusions. A cost-effectiveness analysis was then performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500. Results A total of 93,105 cases were identified with an overall transfusion rate of 1.89%. On multivariate modeling, statistically significant factors associated with transfusion included nonelective admission (odds ratio [OR]: 2.32; 95% confidence interval [CI]: 1.78–3.02), anemia (OR: 4.42; 95% CI: 3.35–5.83), coagulopathy (OR: 4.72; 95% CI: 2.94–7.57), diabetes (OR: 1.45; 95% CI: 1.14–1.84), liver disease (OR: 2.37; 95% CI: 1.27–4.43), pulmonary circulation disorders (OR: 3.28; 95% CI: 1.71–6.29), and metastatic cancer (OR: 5.85; 95% CI: 2.63–13.0; p < 0.01 for all). The ICER of preoperative T/S was $3,576 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S. Conclusion Routine preoperative T/S does not represent a cost-effective practice for these surgeries using nationally representative data. A selective T/S policy for high-risk patients may reduce costs.

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Selective type & screen for elective colectomy based on a transfusion risk score may generate substantial cost savings

et al. 2022

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Are Type and Screen Samples Routinely Necessary Before Laparoscopic Cholecystectomy?

Cited by 7 publications

References 18 publications

Requirement of preoperative blood typing for cholecystectomy and appendectomy: a systematic review

Requirement of preoperative blood typing for cholecystectomy and appendectomy: a systematic review

Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries

Selective type & screen for elective colectomy based on a transfusion risk score may generate substantial cost savings

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