Publications
Preoperative cross-matching in major elective surgical procedures in children: An audit of department’s transfusion practices
Raju, Rajkiran Srinivas; Mahadevaiah, Shubha Attibele; Devi, Shanthala A. M. Abstract
AIMS:
To determine the utilization of cross-matched packed red blood cell (PRBC) concentrate in children posted for major elective operative procedures. To evaluate the efficacy of a simple preoperative “screening criteria” for ordering preoperative cross-match.
MATERIALS AND METHODS:
Data were retrieved from online surgery scheduling system prospectively over a 4-month period (January–April 2022). The number of units cross-matched and those utilized were assessed. A screening criterion was devised in consultation with stakeholders for ordering blood. The utilization of PRBCs was reassessed after implementation of these criteria and reaudited (July–October 2022). A subset analysis of A1 (tunneled catheter placements) and A2 (core pediatric surgical procedures) groups was done to analyze blood utilization.
RESULTS:
Initial audit showed poor PRBC utilization with 46 units unused of the 54 cross-matched units, and most of these were from A1 group (3 of 29 units and 5 out of 25 units utilized in A1 and A2 groups, respectively). Reaudit after introducing cutoff criteria showed sharp decline (79.3%) in the number of cross-matched units and the number of units returned (84.6% decrease) in A1 group and the number of units returned unused dropped by 50% in the A2 group. There was visible reversal of indicators of utilization (cross-match to transfusion ratio dropped from 6.75 to 1.73 and TI increased from 0.163 to 0.613), indicating optimal utilization.
CONCLUSION:
This pilot audit clearly demonstrates the gap between requisition and utilization of cross-matched PRBCs. Formulating an effective screening criterion avoids unnecessary cross-matching and wastage of resources and maximizes utilization. Blood product transfusion (BPT) is a valuable resource in the resuscitation armamentarium. In major surgical procedures, there may be anticipation of blood loss at surgery or an inherent patient predisposition to excessive blood loss. This expectation has led to routine preoperative blood ordering before major elective procedures. Although the practice is universal, actual utilization of the reserved blood is often discrepant. Such practices result in shortage of blood products to deserving candidates with overburdening of blood banking services by increasing the consumption of reagents and testing kits causing increased expenses to patients. There are various precedents of gross underutilization and wastage resulting from such practices. Blood prescription practices for elective major surgical procedures are not standardized and disparities exist not only within institutes across various departments but also across the geographic areas. Necessity for BPT during surgery may arise either as a result of anticipated loss during the operative procedure or due to inherent preoperative suboptimal blood depleted state due to various conditions. Blood products are soon becoming scarce resources with booming global population explosion and decreasing voluntary blood donations. Development of simple and widely applicable checklists for ordering blood prescriptions could avoid return of unutilized cross-matched blood products, thereby reducing the wastage and costs to patients and hospitals.
This study aimed to audit the prevalent BPT practices in children undergoing major elective surgical procedures at a tertiary care hospital with the following aims and objectives. It was reaudited after introduction of a simple criterion for screening these blood prescriptions to complete the audit cycle.
Aims
- To determine the utilization of cross-matched packed red blood cell (PRBC) concentrate in children posted for major elective operative procedures
- To evaluate the efficacy of simple preoperative “screening criteria” for cross-matching patients posted for elective major procedures and reaudit the effectiveness of this intervention
