TH8.7 Impact of routine G&S in Laparoscopic Cholecystectomy on the Trust Resources

Abstract

Background Despite consistently low bleeding rates in laparoscopic cholecystectomy (LC) (0.1 – 0.46%), preoperative testing of ABO group and Rh (D) – G&S – remain common practice throughout UK hospitals. Current NICE guidelines for routine pre-operative tests for elective surgery don't include routine G&S. Additionally, there have been few recently published articles regarding elective and emergency LC suggesting that the routine practice of G&S are unnecessary, potentially delaying surgeries with significant financial impact. Based on published data, if a patient undergoing LC requires perioperative blood transfusion there is no time to cross match, therefore the major hemorrhage protocol is activated and patient is transfused O negative. Aim This project aimed to assess the need for routine G&S in laparoscopic cholecystectomy including impact on Trust resources, national shortage of blood tubes. Methods Retrospective data collection regarding 448 patients that underwent LC at Northern General Hospital, Sheffield in 2020. Results Between January and December 2020 401 G&S samples were taken during the preoperative assessment, and 425 second G&S samples taken on the day of surgery. Antibodies were identified in 8 patients, although they were not cross matched. Furthermore, none of the 448 patients required blood transfusion during the perioperative period. Conclusions Our results highlight that current compliance with NICE guidelines/recent published data is suboptimal. Overall, collecting G&S samples perioperatively takes up resources, time and can delay surgery. Furthermore, Trust savings could be in excess of £8000 in one year. Hence, we are currently reviewing our local policy.