Can Maximum Surgical Blood Order Schedule Be Used as a Predictor of Successful Completion of Bloodless Surgery?

Abstract

BackgroundThe Soonchunhyang University Hospital Bloodless Center was established in 2000, and more than 2,000 bloodless surgeries have been performed there since. In this study, the lowest postoperative Hb/preoperative Hb (Hblow/pre) ratio and mortality rates of patients who underwent bloodless surgery were analyzed for each maximum surgical blood order schedule (MSBOS) category to assess whether MSBOS can be used as a predictor of successful completion of bloodless surgery.MethodsA total of 971 patients were included. MSBOS was defined as the average number of units of RBCs transfused during each elective surgery. We used the Hblow/pre ratio as an alternative to intraoperative blood loss. Frequency of Hblow/pre ratios ≤0.5, use of transfusion alternatives, and mortality rates were compared across MSBOS categories.ResultsOut of the 971 patients, 701 (72.2%) were categorized as type and screen (T&S), 184 (18.9%) as MSBOS 1, 64 (6.6%) as MSBOS 2, and 22 (2.3%) as MSBOS 4. Transfusion alternatives were used by 397 (40.9%) patients. The frequency of the use of simultaneous erythropoietin and iron, hemostatics, acute normovolemic hemodilution, and Cell Saver (Haemonetics corp., USA) was higher in patients in the higher MSBOS categories. Six (0.6%) patients died within 30 days of surgery. Hblow/pre ratios tended to be lower as the level of MSBOS category increased.ConclusionsSurgeries in the higher MSBOS categories tended to be associated with high blood loss and mortality. Active use of transfusion alternatives is recommended in patients in high MSBOS categories who are scheduled to undergo bloodless surgery.

Cirurgia abdominal de alta complexidade: classificação e escolha dos equipamentos pela equipe multiprofissional

“…Já para o sistema público, alguns equipamentos são disponíveis, mas não em quantidade suficiente para todas as salas de cirurgia. Os cirurgiões da instituição B consideraram o cell saver (sistema de reaproveitamento sanguíneo) pouco utilizado para os procedimentos abdominais de AC; e ele está disponível conforme a preferência do cirurgião 20 . A cirurgia robótica vem evoluindo enquanto os profissionais aperfeiçoam a sua técnica, sendo disponível a algumas instituições privadas e públicas de saúde, que a utilizam de forma experimental e acadêmica.…”

Optimal preoperative autologous blood storage volume required in surgeries for placenta previas and low‐lying placentas

“…The maximum surgical blood order schedule (MSBOS) is the maximum blood volume that should be cross‐matched in preparation for the surgery. We calculated the crossmatch‐to‐transfusion ratio (C/T ratio) on the basis of previous surgical procedures that were undertaken in the hospital, and determined that a C/T ratio of ≥1.5–2.5 was appropriate . The Japanese guidelines for implementing blood therapy also indicate that a C/T ratio of 1.5 or lower is appropriate; thus, MSBOS was calculated as follows: ([mean autologous blood usage volume + mean red cell concentrate {RCC} usage volume] × 1.5).…”