Pre-Operative Routine Cross-match for Elective Breast Surgery: An Appropriate Use of Resources?

Abstract

Background and Objective: Routine cross-matched blood preparation preoperatively without transfusion can lead to a costly waste of resources. A 12-month report from our blood bank demonstrated an inappropriate use of preoperative blood order with the blood cross-match to transfusion (C/T) ratio of 2.08 (62,300/29,893 units). This study aims to determine the efficiency of blood ordering in elective breast surgery before implementation of a blood order guideline.

Methods: Consecutive elective breast surgery  from January to December 2011 were identified retrospectively using an electronic management information system of Srinagarind hospital. Patients transfused pre-operatively were excluded. Pre-operative cross-match status and blood transfusion data for each patient were identified from the medical and anesthetic records. Cross-match to transfusion (C/T) ratio and blood usage parameters (transfusion probability;%T and  transfusion index; Ti) were calculated.

Results: There were 195 patients undergone breast surgery. 233 units of pack red blood cell were prepared for   185 cases. Only 8 units of the prepared blood were used for the 6 patients.  The total expense for the blood preparation was 63,720 baht, while the expense of  the actual transfused blood was 2,160 baht. T he C/T ratio was 29.1.  The calculated transfusion probability (%T) and Ti were 3.24 and 0.04 respectively.

Conclusion: This study shows the over-ordering blood for elective breast surgery and cannot justify performing a routine pre-operative cross-match. Blood should be typed and screened preoperatively and cross-matched only when clinically indicated to minimize inappropriate request and  expenditure, and to improve blood stock management.

Keyword: Routine cross-matched preoperatively, elective breast surgery