PD43-05 QI: DO WE NEED PRE-OP GROUP AND SCREEN SAMPLES AND ROUTINE POST-OP BLOODS FOR RARP

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-05 QI: DO WE NEED PRE-OP GROUP AND SCREEN SAMPLES AND ROUTINE POST-OP BLOODS FOR RARP Arjun Nathan*, Ashwin Sridhar, Anand Kelkar, Greg Shaw, Tim Briggs, John Kelly, Senthil Nathan, Prabhakar Rajan, and Prasanna Sooriakumaran Arjun Nathan*Arjun Nathan* More articles by this author , Ashwin SridharAshwin Sridhar More articles by this author , Anand KelkarAnand Kelkar More articles by this author , Greg ShawGreg Shaw More articles by this author , Tim BriggsTim Briggs More articles by this author , John KellyJohn Kelly More articles by this author , Senthil NathanSenthil Nathan More articles by this author , Prabhakar RajanPrabhakar Rajan More articles by this author , and Prasanna SooriakumaranPrasanna Sooriakumaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients undergoing Robotic Assisted Radical Prostatectomy (RARP) commonly require 2 group and screen samples pre-operatively. However, literature suggests intra-operative transfusion rates are between 0.7 – 2%. Additionally, day 1 post-operative blood tests are routinely undertaken in urology centres around the world. We aim to assess the need for 2 group and screen samples pre-operatively and the need for routine post-operative blood tests. METHODS: We retrospectively reviewed 310 patients who underwent a primary or salvage RARP operation. All patients were operated on at University College London Hospital (UCLH) over a 6-month period. RESULTS: Pre-Operative The median age of our patients was 66 with a median ASA of 2. 26% of patients had Charlson Co-Morbidities. Intra-Operative 21% of patients underwent pelvic lymph node dis section. 31% had no nerve sparing, 30% had unilateral nerve sparing and 38% had bilateral nerve sparing. Our median op-time was between 120 and 240 minutes and our median estimated blood loss was 200mls (IQR: 100-350). 7.1% of our series had BAUS intra-operative complications 0.3% (N=1) of patients received an intra-operative blood transfusion.Post-Operative 1.3% (N=4) of patients received a post-operative blood transfusion. Our median length of stay was 1 day (IQR: 1-2). 9.4% (N=29) of patients had a delayed discharge due to delayed routine blood results.Analysis 7% were judged to need post-operative higher dependency care and necessary blood tests. 3% had blood tests requested from intra-operative suspicion and 19% had blood tests requested from clinical post-operative suspicion. 71% had routine blood tests requested with no justification. 5.2% of patients (N=16) had post-operative complications; 4 patients had blood tests requested from intra-operative suspicion, 11 patients had blood tests requested from overnight or day 1 clinical suspicion and 1 patient suffered a complication (haematoma) that was not picked up from clinical suspicion, or routine blood tests. CONCLUSIONS: Intra-operative or post-operative clinical judgement flagged post-operative complications in 99% of patients. Routine blood tests, without an indication, did not flag any (0%) post-operative complications that were not flagged by clinical judgement. The use of a second Group and Screen samples was not useful intra-operatively. By removing unnecessary blood tests, we would save our trust roughly £5000 a month as well as reducing delays in discharge and workload on medical staff. Furthermore, we would maintain the same level of patient safety and care. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e902-e902 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arjun Nathan* More articles by this author Ashwin Sridhar More articles by this author Anand Kelkar More articles by this author Greg Shaw More articles by this author Tim Briggs More articles by this author John Kelly More articles by this author Senthil Nathan More articles by this author Prabhakar Rajan More articles by this author Prasanna Sooriakumaran More articles by this author Expand All Advertisement PDF downloadLoading ...