An Appropriate Use of Routine Cross-Match of Pre-Operative Blood Preparation for Elective Knee and Hip Surgery

Abstract

Background and objective :  Routine cross-matched blood preparation preoperatively without transfusion leads 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 aim to determine the efficiency of blood ordering in elective knee and hip surgery before implementation of a blood order guideline.

Methods: Consecutive elective knee and hip 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 using medical and anesthetic records. Cross-match to transfusion (C/T) ratio and blood usage parameters (transfusion probability; %T and transfusion index; Ti) was calculated.

Results: There were 170 patients who underwent elective knee and hip surgery. They had preparing blood for surgery 303 units for patients with 169 cases. Only 75 units in 56 patients had been transfused. Transfusion utilization indices, C/T ratio equal to 4.04 % T and Ti were 33.14 and 0.44 Total cost for the cross-matching process is 81,810 baht, but it is actually used 20,250 baht.

Conclusion: This study shows the over-ordering blood for elective knee and hip surgery and cannot justify performing a routine pre-operative cross-match.