37 Examining the utility and cost of routine preoperative type and screen prior to minimally invasive hysterectomy

Abstract

This study aims to examine the utility and cost of obtaining routine preoperative type and screen (T&S) in patients undergoing minimally invasive hysterectomy (MIH). Secondary aims included comparison of the proportion of cases with routine T&S ordered with perioperative blood transfusion rates and calculation of potential cost-savings by omitting routine T&S. Our study was a retrospective chart review of all patients who underwent MIH (laparoscopic and robotic) from January 1, 2018 to December 31, 2019. Patient demographics, comorbidities, and surgery parameters were abstracted. Primary outcome measures included the proportion of MIH that had a preoperative T&S ordered and the rate of perioperative blood transfusion. Descriptive statistical tests were performed. Data were analyzed using Chi-square tests for categorical variables and student’s t-test for continuous variables. Logistic regression was used to determine the relationship between preoperative hemoglobin (Hgb) and perioperative transfusion status. An ROC curve was used to determine the cut-point value of preoperative Hgb to predict a transfusion. All analyses were conducted using SPSS version 26. In the study period, 307 primarily White/Non-Hispanic (58%) women, with a mean age of 54 years (SD = 12.6) underwent an MIH. There were no differences in baseline demographics between cases with T&S ordered compared to cases without T&S ordered. Most cases (56.4%) were performed for benign indications. Of 307 cases, 42.7% had T&S ordered and only 2.9% (9 cases) required blood transfusion. The cost of T&S at our institution was estimated to be $193.39. If routine preoperative T&S was eliminated, we calculated an annual cost savings of $11,590/year. The proportion of cases with T&S ordered and perioperative transfusion rate did not significantly differ between benign versus oncologic cases. A higher proportion of patients with anemia (32%) had a T&S ordered compared to patients without anemia (14%) (P = 0.001). Two-thirds of patients receiving transfusion had a history of anemia (P = 0.004). The odds ratio between preoperative Hgb and transfusion status is 0.293 (95% CI = 0.16 to 0.47; P < 0.001). Among patients with a preoperative Hgb below 10.6 gm/dL (n = 30), the probability of a transfusion was 27%; while those with a preoperative Hgb above 10.6 gm/dL (n = 264), the probability of not receiving a transfusion was 99%. Only 2.9% of MIH required blood transfusion, but 42.7% of cases had T&S ordered. The majority of patients receiving transfusion had history of anemia, indicating that T&S may be reasonable in these patients. Knowledge of preoperative hemoglobin level may also be helpful in determination of patients at greater risk of perioperative transfusion.