EP.TH.860Audit to review the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests obtained

Abstract

Abstract Aims Open hernia repair is a common elective and emergency surgical procedure. The majority of hernia repairs are performed without complications. Current dogma dictates 2 pre-operative group and save tests must be obtained prior to hernia repair. Post-operative haemorrhage is rare and there is equipoise as to whether all patients must be group and saved pre-operatively. Methods Retrospective review of electronic patient records between April 2018 to March 2019 in a large district general hospital. Cross referencing of operative, blood transfusion and blood science records was performed. Results 410 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed. The hernia repairs were elective and emergency procedures with patients ASA 1 - 5. A total of 820 pre-operative group and save test were obtained with a total cost of £7,978.60. The post-operative blood transfusion rate was 1.46%. Conclusions A large number of open hernia repairs were performed over a 12-month period with a very low post-operative blood transfusion rate. This small single centre study indicates that many pre-operative group and save tests may be unnecessary as the majority of hernia repairs were performed without post-operative blood transfusion. Abolishing unnecessary group and save tests could reduce clinical and financial burden without compromising patient safety. The study also suggests that a selective group and save policy be instituted for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction for incisional hernia. A selective group and save policy will be implemented and re-audit in 6 months.