Maximum Surgical Blood Ordering Schedule for Cancer Surgeries

Abstract

Background and Objectives: Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence-based estimates. In the absence of an explicit maximum blood demand policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence-based estimates of average requirement in a particular surgery. Maximum surgical blood order schedule (MSBOS) is a criterion developed from institutional usage statistics providing a figure for the number of units to be crossmatched for any given surgical procedure. Aims and objectives of this study were to prepare and implement MSBOS, to increase blood availability to other medical patients and surgical patients. Promote efficient use of blood inventory, workforce, and consumables. This also helps to reduce unnecessary pre transfusion testing and cross match studies. Methodology: A retrospective analysis of various surgeries was done and then, a maximum surgical blood order schedule (MSBOS) was prepared and implemented and various parameters were analyzed in the largest tertiary cancer care hospital of Gujarat over a 2-year period. The goal was to study the blood ordering strategies in the hospital for surgical patients and evolve an MSBOS. The total units demanded and the corresponding units issued were studied for surgical patients. Thereafter, transfusion probability, transfusion index (TI), and ratio of units crossmatched to actual units transfused (C/T ratio) were calculated. Transfusion guidelines for all surgeries requiring transfusions were proposed and implemented. Results: Crossmatch to transfusion ratio improved from 9.54 to 3.68. Transfusion probability was down to 30.04 from 13.24 and TI increased to 0.31 from 0.179. P value by using Z test for all three parameters was <0.05. Conclusions: Z-test calculation showed significant statistical improvement in the above three measures. The study also identified the common cases where “Type and Screen” (T and S) procedure could be introduced in cases where the transfusion probability was low. The implementation of this proposal will avoid over ordering of blood which is beneficial to the institute.