Proposed maximum surgical blood ordering schedule for common orthopedic surgeries in a Tertiary Health - Care Center in Northern India

Abstract

BACKGROUND: Blood transfusion is the cornerstone of therapy for many serious ailments, surgical and trauma patients. Patients undergoing orthopedic surgeries as elective procedure or emergency orthopedic surgery for trauma often experience excessive blood loss- requiring transfusions. However, preoperative placement of blood requests frequently overshoots the actual need resulting in unnecessary crossmatching, which can be reduced by formulating maximum surgical blood ordering schedule (MSBOS). It is a table of elective surgical procedures, which lists the number of units of blood routinely cross-matched pre-operatively. OBJECTIVE: The objective of this study is to audit the blood utilization in orthopedic surgeries so that unnecessary cross-matching, wastage of blood bank resources, and financial losses to the patients could be reduced. MATERIALS AND METHODS: A retrospective study was carried out in our tertiary care hospital over a period of 6 months to determine the utilization of blood during different orthopedic procedures and to recommend an appropriate blood ordering schedule. The data collected include patient's requests, patient's transfused, type of surgical procedure, number of units crossmatched and transfused, crossmatch to transfusion ratio (CTR) and transfusion indices (TI's); according to them, MSBOS was proposed. RESULTS: A total of 478 units of blood were crossmatched for 273 patients and only 243 units were transfused to 183 patients. About 50.8% of the crossmatched units and 67% of the total patients were transfused. Seven out of the thirteen procedures had a CTR higher than 2, low TI ≤0.5 and blood utilization ≤50%. Fracture forearm and unilateral total knee replacement have the transfusion probability of ≤30%, so implementation of type and screen policy was recommended for these two procedures. CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.