EP.TH.449Routine G&S in elective laparoscopic cholecystectomy and the impact on NHS resources

Abstract

Abstract Aim Current guidelines for routine pre-operative tests for elective surgery, don’t mention routine Group & Save (G&S). At present the need for G&S sample is dependent on the operative severity and the likelihood of blood loss. However, despite consistently low major bleeding rates in elective laparoscopic cholecystectomy (ELC) (0.1 – 0.46%) many hospitals, including ours, still hold local policies to have routine G&S pre-operatively and/or on the day of surgery. Our aim is to audit our hospitals local policy regarding G&S samples in ELC and establish its necessity and financial impact. Methods Retrospective study looking at adult patients undergoing ELC at University Hospitals Birmingham NHS Foundation Trust in 2020. Results 344 ELC procedures were carried out in 2020. Of those 82 had no G&S, 137 had pre-op sample taken with no following samples, with a total of 182 samples sent on the day of surgery. Antibodies were identified in 5 patients (1,45%) however none were cross-matched before surgery. Only 1 patient needed transfusion in the peri-operative period and was cross-matched from sample sent after surgery. Conclusion Based on our results the likelihood of having peri-operative bleeding in ELC requiring blood transfusion is minimal (0.29%), therefore the need for routine G&S in this context is questionable. Arguably, diagnosing antibodies in itself would justify one G&S sample. In agreement with this our results show that in 2020 our Trust spent unnecessarily more that 2’431£, additionally adding workload to already stretched staff and delaying theatres.