Routine Preoperative Typing and Screening: A Safeguard or a Misuse of Resources

Ghirardo, Silvio Fabian; Mohan, Ishwaria; Gomensoro, Alicia; Chorost, Mitchell I.

doi:10.4293/108680810x12924466007241

Cited by 29 publications

(22 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ghirardo et al replicated these results in 3,424 patient undergoing moderate risk general surgery procedures and again found little evidence to support mandatory preoperative T&S in light of 0.32% overall RBC transfusion rate. 16 Finally, Dexter et al confirmed the threshold of 5% predicted individual transfusion risk as appropriate to trigger preoperative T&S. 17 Beyond institutional requirements another reason that T&S are oftentimes ordered is that surgeons tend to over-utilize laboratory testing, possibly for medico-legal reasons or in the case of vascular surgeons, due to habituation to high risk procedures. 18 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of “type and screen”

Stangenberg

Curran

Shuja

et al. 2016

Journal of Vascular Surgery

View full text Add to dashboard Cite

Objectives Preoperative testing for carotid endarterectomy (CEA) often includes blood typing and antibody screen (T&S). In our institutional experience, however, transfusion for CEA is rare. We assessed transfusion rate and risk factors in a national clinical database to identify a cohort of patients in whom T&S can safely be avoided with the potential for substantial cost savings. Methods Using the NSQIP database, transfusion events and timing were established for all elective CEAs in 2012–13. Comorbidities and other characteristics were compared for patients receiving intra- or postoperative transfusion and those that did not. After random assignment of the total data to either a training or validation set, a prediction model for transfusion risk was created and subsequently validated. Results Of 16,043 patients undergoing CEA in 2012–13, 276 received at least one transfusion prior to discharge (1.7%). 42% of transfusions occurred on the day of surgery. Preoperative hematocrit < 30% (Odds ration OR: 57.4; 95% confidence interval CI: 29.6–111.1), history of congestive heart failure (OR: 2.8; 95%CI: 1.1 – 7.1), dependent functional status (OR: 2.7; 95%CI: 1.5–5.1), coagulopathy (OR: 2.5; 95%CI: 1.7–3.6), creatinine ≥ 1.2 mg/dl (OR: 2.3; 95%CI: 1.6–3.3) preoperative dyspnea (OR: 2.0; 95%CI: 1.4–3.1) and female gender (OR: 1.6; 95%CI: 1.1–2.3) predicted transfusion. A risk prediction model based on these data produced a C-statistic of 0.85; application of this model to the validation set demonstrated a C-statistic of 0.81. 93% of patients in the validation set received a score of 6 or less corresponding to an individual predicted transfusion risk of 5% or less. Omitting a T&S in these patients would generate a substantial annual cost saving for NSQIP hospitals. Conclusions While T&S is commonly performed for patients undergoing CEA, transfusion following CEA is rare and well predicted by a transfusion risk score. Avoidance of T&S in this low-risk population provides a substantial cost-saving opportunity without compromise of patient care.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Rapid administration of O-negative blood acceptably addresses any hemodynamic instability in an emergency situation with evidence that no patient has died from a transfusion complication and the rate of seroconversion in Rh-negative patients is low. 16 …”

Section: Discussionmentioning

confidence: 99%

Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of “type and screen”

Stangenberg

Curran

Shuja

et al. 2016

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Laboratory tests include white blood count which may be useful in evaluating the postoperative outcome, in particular in patients with complications such as infections, or to check the evolution of leukocytosis when surgery is performed for acute cholecystitis [352]. Since the risk of transfusions is 0.7% for laparoscopic cholecystectomy (slightly higher in case of ''open procedure"), even the routine preoperative evaluation of haemoglobin and haematocrit is not considered mandatory [352,353]. Platelets count, international normalized ratio and partial thromboplastin time are often screened and requested to evaluate coagulation factors in patients scheduled for surgery.…”

Section: Preoperative Investigationsmentioning

confidence: 99%

EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones

2016

Journal of Hepatology

433

165

View full text Add to dashboard Cite

“…30 Recently, Katz et al evaluated preoperative testing, recommended that hospitals screen for unnecessary tests, and recommended further investigation whether the benchmarked value to compare providers can be the percentage of patients with at least one unnecessary test. 1 Tsai's and Polk's subsequent Letter to the Editor emphasized the need to reduce variability in preoperative testing among providers.…”

Section: Discussionmentioning

confidence: 99%

Systematic Criteria for Type and Screen Based on Procedure's Probability of Erythrocyte Transfusion

Dexter¹,

Ledolter

Davis

et al. 2012

Anesthesiology

View full text Add to dashboard Cite

Background: At many hospitals, the type and screen decision is guided by the hospital's maximum surgical blood order schedule, a document that includes for each scheduled (elective) surgical procedure a recommendation of whether a preoperative type and screen be performed. There is substantial heterogeneity in the scientific literature for how that decision should be made. Methods: Anesthesia information management system data were retrieved from the 160,207 scheduled noncardiac cases in adults of 1,253 procedures at a hospital. Results: Neither assuming a Poisson distribution of mean erythrocyte units transfused, nor grouping rare procedures into larger groups based on their anesthesia Current Procedural Terminology code, was reliable. In contrast, procedures could be defined to have minimal estimated blood loss (less than 50 ml) based on low incidence of transfusion and low incidence of the hemoglobin being checked preoperatively. Among these procedures, when the lower 95% confidence limit

show abstract

Routine Preoperative Typing and Screening: A Safeguard or a Misuse of Resources

Abstract: The probability of requiring blood products for cholecystectomy, hernia repair, and appendectomy is low. The authors, therefore, suggest the elimination of routine typing and screening before these procedures.

Cited by 29 publications

References 9 publications

Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of “type and screen”

Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of “type and screen”

EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones

Systematic Criteria for Type and Screen Based on Procedure's Probability of Erythrocyte Transfusion

Contact Info

Product

Resources

About