Background: Routine group and save (G&S) testing is frequently performed prior to cholecystectomy, despite growing evidence that a targeted approach is safe and avoids unnecessary investigations. This retrospective cohort study explored frequency of testing in our unit, rates of peri-operative blood transfusion and pre-operative risk factors for requiring transfusion.
Methods: Health records of 453 consecutive adults who underwent cholecystectomy in a UK NHS trust were reviewed for blood transfusion up to 30 days post-operatively. We compared the need for transfusion against patient demographics, indication and urgency of surgery, and the number of prior emergency hospital attendances with gallstone complications. Logistic regression determined whether prior attendances with complications of gallstones independently predicted the need for transfusion.
Results: Peri-operative blood transfusions within 30 days of operation occurred in 1.1% of cases, with no requirement for uncrossmatched blood. Patients who received a blood transfusion tended to have higher American Society of Anesthesiologists (ASA) grades ( p = 0.017), were more likely to have an underlying primary haematological malignancy (20.0% vs. 0.2%; p = 0.022) and prior emergency hospital attendances with gallstone complications (median 4 vs. 1; p < 0.001). Logistic regression showed each prior emergency attendance was associated with 4.6-fold odds of transfusion ( p = 0.019). Receiver operating characteristic curve analysis showed an area under the curve of 0.92. Three or more attendances predicted need for transfusion with 60.0% sensitivity and 98.0% specificity. 74% of patients had at least one G&S sample taken pre-operatively, costing the trust approximately £3,800 per year in materials.
Conclusions: The findings of this study suggest that pre-operative G&S testing prior to cholecystectomy is not routinely required. Increased frequency of prior emergency hospital attendances with gallstone complications and co-morbidities associated with coagulopathies were pre-operative risk factors for post-operative blood transfusion. More selective testing could provide large financial savings for health institutions without compromising patient safety.
Keywords: Blood transfusion; blood typing; cholecystectomy; crossmatching; gallstones; group and save; haemorrhage; type and save.
Many patients diagnosed with gallstones undergo surgery to remove their gallbladder. Blood tests are routinely performed in clinic before the operation, which may include testing a patient’s blood type in case of bleeding during or after the operation. This test is required before a patient receives a blood transfusion. Testing the blood type of patients prior to gallbladder surgery may not be routinely required, as excessive bleeding from this operation is rare. Avoiding unnecessary blood tests protects patients from unwarranted needles, prevents delays to surgery and saves hospitals money. We therefore investigated how frequently patients undergoing gallbladder surgery in our unit have blood type testing. We also assessed how often patients require a blood transfusion and whether testing for blood type could have been safely performed once the need for transfusion was identified, instead of before the operation. Looking back at 453 patients’ notes, we found that only five needed a blood transfusion within 30 days of their operation. None of these blood transfusions were needed on an emergency basis, and therefore there would have been enough time to test these patients for their blood type without having to test them before the operation. Despite this, nearly three-quarters of our patients had blood type testing before the operation. Each of these tests costs an estimated £11 per sample in our unit, and therefore £3,800 per year could have been saved were these tests not performed. The five patients who required a transfusion were found to have attended hospital more times before their operation with problems related to gallstones. Therefore, our study provides evidence that performing gallbladder operations on a more urgent basis following an admission to hospital with gallstone complications could reduce a patients’ risk of bleeding.
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