Maximum Surgical Blood Order Schedule Research Articles

Efficacy of Blood Utilization in Elective Surgery for Non-COVID Patients during COVID-19 Outbreaks

Objective: This study aimed to evaluate the pattern of blood transfusion requests and utilization in non-coronavirus disease (COVID) patients having undergone elective surgeries during the COVID-19 pandemic. Material and Methods: The pattern of blood transfusion requests and utilization for elective surgical procedures in six departments of a University Hospital; between January 2020 and December 2021, were retrospectively evaluated. The cross-match-to transfusion (C/T) ratio, transfusion probability (%T), transfusion index (Ti), and maximum surgical blood order schedule (MSBOS) were calculated. Results: A total of 15,030 patients underwent elective surgery. Among the 14,426 units of blood requested, 12,776 (89%) units were cross-matched preoperatively for 5,799 (39%) patients, and an additional 1,650 (11%) units were requested for 394 (2.6%) patients intraoperatively. Among these, 4,588 (32%) units were transfused to 1,710 (11.4%) patients. The overall C/T ratio, %T, and Ti were 2.78, 29.5%, and 0.79, respectively. Blood utilization indices for each department varied substantially according to the type of surgery, with blood utilization indices being unfavorable for 68 (80%) of the 85 procedures. The MSBOS was 0 for 32 procedures. Conclusion: Over-ordering of blood units for elective surgical procedures remained common during the COVID-19 pandemic. The blood utilization indices showed substantial variations according to the type of surgical procedures. The MSBOS has been formulated to assist in future decision-making.

Maximum Surgical Blood Ordering Schedule in Common Pediatric Cardiac Surgeries in a Tertiary Center.

Unnecessary pre-operative ordering of red blood cells (RBCs) in elective surgeries increases costs and waste of blood inventory. Maximum surgical blood order schedule (MSBOS) is a helpful strategy in the estimation of blood units needed for surgery and the prevention of overconsumption. In this study, an MSBOS for pediatric cardiac surgeries is designed. In this cross-sectional study, we included all pediatric patients who underwent elective cardiac surgery in Children's Medical Center in Tehran, Iran, from March 21, 2019, to September 22, 2019. Data consisted of the type of surgery and the number of blood units transfused and units cross-matched, based on which cross-match to transfusion ratio (CTR), the transfusion index (TI), and transfusion probability (T%) were calculated. Overall 205 pediatric patients were included in the study. Four hundred and ten RBCs units were cross-matched, and 262 were transfused. The overall results of the CTR, T%, and TI for all the eight types of cardiac surgery were 1.56 (410/262), 76% (157/205), and 1.28 (262/205), respectively. The raw MSBOS for cardiac surgeries included ventricular septal defect, tetralogy of fallot, dextro-transposition of the great arteries, atrial septal defect, aortic coarctation, patent ductus arteriosus, pulmonary stenosis, and pacemaker insertion, which were 1.58, 1.03, 1.54, 1.66, 0.77, 0, 1.25, and 0 unit, respectively, and the figures were rounded up. Accurate MSBOS protocols reduce cross-match workload in laboratories, lead to the appropriate use of blood stocks with less wastage, save human and economic resources, and eventually, promote patient safety.

Hemodynamic monitoring in liver Transplantation patients in the third millennium

In patients undergoing orthotopic liver transplantation (OLTx) surgery, the intraoperative hemodynamic monitoring technique that is most utilized is still the pulmonary artery catheter (PAC). The popularity of transesophageal echocardiography (TEE) is increasing, so today's updated issue is the following: should the use of PAC and/or volumetric monitoring with transpulmonary thermodilution and/or advanced volumetric PAC be limited in clinical practice, only for some high risk patients? Could we use the TEE, if necessary, in less critical ill patients undergoing OLTx surgery? We can integrate all of the aforementioned monitoring techniques in an increasing modular step wise monitoring concept. But in an uncertain hemodynamic situation, transthoracic and/or transoesophageal echocardiographic evaluation represents a cornerstone. The use of echocardiography during OLTx is more and more common with several benefits demonstrated particularly by the TEE in this patient population. To achieve and maintain adequate tissue perfusion becomes difficult in case of major bleeding, an event quite possible to occur during OLTx, affecting the immediate and the late outcome. All the clinicians agree that bleeding interfere with the choice of hemodynamic monitoring and or vice versa. A reasonable compromise is to find a balance between the need to extend monitoring in high-risk surgical patients and the average consumption of blood products that characterizes each individual transplant center. This is also in line with what is shown in literature in terms of Maximum Surgical Blood Ordering Schedule (MSBOS).

Maximum surgical blood order schedule in urology surgery

Aim: To improve patient blood management (PBM), a special system of collecting and testing blood units has been developed. It defines the maximum number of allogeneic red blood cell components necessary for certain surgical interventions. This system is referred to as "The Maximum Surgical Blood Order Schedule" (MSBOS). The aim of the study was to evaluate the rationality of red blood cell consumption during urological surgeries. Materials and Methods: During the course of one year, a retrospective study was conducted on 617 patients. The study included 185 women and 432 men, with a median age range of 60 years old (ranging from 45 to 75 years old). The consumption of red blood cell units was evaluated in relation to the primary indication and type of surgery, preoperative data on hemoglobin values, and coagulation tests. Results: The overall C:T ratio was 4.2, which corresponds to 24% of transfused units in relation to the number of cross-match tests performed. A statistically significant difference in the average related to the age was observed between the subjects in whom there was irrational (64.65±9.49 years) and those in whom there was a rational use of red blood cells. A statistically significant difference was also observed in the frequency of different primary diagnoses according to the International Diseases Classification) and in relation to the values of hemoglobin and prothrombin time (PT) between the group with rational and irrational use of red blood cells. Conclusion: The obtained data showed unreasonable use of RBC based on the C:T ratio and therefore the necessity of introducing of PBM system as well the necessity to revise the existing protocols for red blood cell demand according to indications and to improve patient preparation in order to minimize the use of allogeneic red blood cells.

Maximum surgical blood ordering schedule for common Orthopaedic surgical procedures at Birrd hospital (Tertiary orthopaedic hospital)

Maximum surgical blood ordering schedule for common Orthopaedic surgical procedures at Birrd hospital (Tertiary orthopaedic hospital)

Monitoring blood transfusion policies and implementation of maximum surgical blood ordering schedule

Monitoring blood transfusion policies and implementation of maximum surgical blood ordering schedule

Blood ordering and utilization in patients undergoing elective general surgery procedures in a tertiary care hospital: A prospective audit.

Background Blood ordering is commonly done for patients undergoing major elective surgery. Excessive order of the blood for elective surgery leads to wastage of resources, time and workforce. Auditing preoperative blood ordering decreases the cost of medical care by avoiding unnecessary cross-match without compromising patient safety. Methods For this hospital-based audit, we collected data prospectively from July 2017 to June 2018 regarding the transfusion and transfusion indices, namely cross-match-totransfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI) and maximum surgical blood ordering schedule (MSBOS) for elective surgeries done in the Department of Surgery. Results A total of 1151 patients were included in the study. A total of 160 units of blood were issued of which only 138 were transfused to 116 patients. Seventy-one procedures were included in the study. The C/T ratio was less than 2.5 for 16 procedures, T% was >50% for 9 procedures and MSBOS was more than 0.5 for 16 procedures. Conclusion Cross-matching is overused for elective surgical procedures. Only 16 of the 71 procedures had an ideal C/T ratio. Group and screen policy can be adopted for most of the commonly performed procedures, and cross-matching of blood may not be needed.

Blood reservation and utilisation practice for Caesarean section in Ilorin, Nigeria.

Most blood units routinely cross-matched for patients undergoing Caesarean section (CS) in Nigeria are not used for transfusion. Over-ordering increases blood wastage, blood bank running costs, surgery costs and waiting times. A one-year review of all CS performed in the University of Ilorin Teaching Hospital (UITH), Nigeria, was thus conducted to evaluate blood reservation and utilisation practice. Efficiency of blood utilisation was evaluated using a cross-match to transfusion (C/T) ratio, transfusion probability (TP) and transfusion index (TI). The overall C/T ratio, TP and blood wastage were, respectively, 3.1, 24.6%, and 68%, indicative of inefficient blood utilisation. Establishing a Maximal Surgical Blood Order Schedule (MSBOS), which estimates the units of blood required for specific CS indications, is recommended to minimise blood over-ordering. Blood grouping alone should be done for patients at low risk for transfusion. For moderate risk patients, blood type and screen without cross-matching should be done, reserving cross-matching for high-risk patients.

Necessity for Regular Updates of the Maximum Surgical Blood Order Schedule (MSBOS)

Necessity for Regular Updates of the Maximum Surgical Blood Order Schedule (MSBOS)

Maximum surgical blood order schedule for flap reconstruction in oral and maxillofacial cancer patients

BackgroundWe established a MSBOS for flap reconstruction in oral and maxillofacial cancer patients.MethodWe enrolled 2080 cases of oral and maxillofacial flap reconstruction from January 1, 2010 to December 31, 2021. Patient data were collected, including age, sex, BMI, preoperative Hb levels, ASA grade, T stage, flap type, tumor location, and bone flap. Scoring criteria were established based on a multivariate model of independent risk variables and their odds ratios. Two flap-type groups were divided into low-risk, intermediate-risk and high-risk groups by the scoring criteria, and analyzed using univariate and multivariate logistic regression. Perioperative transfusion analysis identified independent risk factors at various Hb levels. The cumulative percentage of patients requiring perioperative blood transfusion for each surgical procedure was calculated to establish the MSBOS.Results(1) Regression analysis showed that BMI, tumor T staging, ASA grade, preoperative Hb level (male: Hb < 130 g/L, female: Hb < 120 g/L), and bone flap were independent risk factors for perioperative blood transfusion. (2) Regression analysis showed that independent risk factors for perioperative transfusion included the following: BMI, tumor T3–T4 stage, ASA III, IV grade, and free flap/pediculated flap/bone flap in patients with different Hb levels; T3–T4 stage, ASA grade III–IV in mildly anemic patients; and ASA grade III–IV in moderately anemic patients. (3) A MSBOS was established for flap reconstruction in head and neck cancer patients.ConclusionA MSBOS for head and neck cancer procedures was reduced by approximately 30% perioperative blood preparation while ensuring that clinical blood use standards were met. It help optimize blood inventory, and save blood resources.

Blood use in elective surgical procedures in a “type A” base hospital

IntroductionBlood orders for surgical patients make up a considerable portion of total blood requests but the majority doesn’t lead to a transfusion. Routine crossmatching and reserving blood for all surgeries can be reduced by establishing a Maximum Surgical Blood Ordering Schedule  [MSBOS]. We have analyzed blood utilization in Base Hospital Puttalam and formulated an MSBOS with this study. Material and methodsA total of 2145 surgeries from surgical and gynaecology &amp; obstetric units in the year 2019 was analyzed. Patients who underwent massive transfusions and patients having a pre-operative haemoglobin concentration less than 8.3g/dl or obtained a pre-operative transfusion were excluded considering transfusions to correct preoperative anaemia. The crossmatch to transfusion ratio [C: T], transfusion probability [T%] and transfusion index [TI] was calculated for each surgical procedure. The procedures having a C: T of &gt;3:1 was recommended for group and screen [G&amp;S].  ResultsOf a total of 2145 patients, 90% were females. A total of 1565 units were requested and 1521 units were crossmatched for 2034 patients while only 193 were transfused. Overall indices for the study population are CT ratio of 7.8:1, %T of 10.4% and TI of 0.15. Indices for surgical unit patients are CT ratio of 5:1, %T of 15.2% and TI of 0.29. By using the MSBOS total of 1403 cross matches could have been avoided. ConclusionsBy implementing the MSBOS 92% of cross matches for elective surgeries could have been avoided. The results are on par with the previous studies done at tertiary health care centres. 

Efficiency of Blood Utilization in Elective Oncosurgeries in a Tertiary Care Cancer Centre: A Case for Data Disaggregation.

Oncosurgeries based on radical resection significantly increase the chances of intraoperative blood transfusion which leads to blood requisition based on subjective anticipation. Periodic audit and revisiting practice based on disaggregating data on the basis of surgical region could preserve blood, which is a scarce resource globally. This report proposes to use the results for reviewing the existing blood ordering schedule, in addition to proposing wider adoption in other cancer institutes using this report as a template. A retrospective analysis was performed for the entire patient cohort who underwent elective oncosurgeries between January 1, 2020, and January 31, 2021, and for whom blood reservation was done. Number of blood units cross matched and transfused for each patient for each surgery was noted. Efficiency of blood utilization was calculated using cross match transfusion ratio (CTR), transfusion probability (TP), and transfusion index (TI) indices and, finally, maximum surgical blood order schedule (MSBOS) was computed. Out of 718 elective oncosurgeries performed, blood requisition of 710 units was made for 345 procedures. Of the total units cross matched, only 76 units (10.70%) were transfused, leaving 89.29% units unutilized. Overall, CTR, TP, and TI were 9.34, 11.59%, and 0.22, respectively. Head and neck surgeries had the highest number of patients cross matched as well as units reserved, but not transfused. Conversely, abdominal surgeries had the highest transfusion probability. There is inefficient blood utilization in elective oncosurgeries and we recommend implementation of MSBOS based on anatomic region to improve efficiency of blood utilization.

A study to formulate maximum surgical blood order schedule at a Tertiary Care Referral Teaching Institute in Andhra Pradesh

Background and Objectives: Blood transfusion is the mainstay of treatment for several serious illnesses, surgical, and trauma patients. The aim of this study is to develop maximum surgical blood order schedule (MSBOS) for surgeries in our institute to formulate certain guidelines to prevent the over-ordering of blood and promote reasonable ordering of blood. Patients and Methods: All the patients undergoing surgeries in General Surgery, Surgical Gastroenterology, surgical oncology, Cardiovascular and Thoracic Surgery, Neurosurgery, Urology, and Orthopedics Departments requesting blood were included in this study. Cross-match-to-transfusion (CT) ratios, transfusion probability (TP), and transfusion index (TI) were calculated for individual specialties and surgeries. Based on these parameters, MSBOS was formulated. Results: During the study period, a total of 2724 patients posted for elective surgical procedures necessitating blood among various surgical departments were included in the study. A total of 5812 units of packed red blood cells were requested and cross-matched for the study population. Among these, 1831 units were transfused with a blood utilization percentage of 31.50% (6%–60%). The overall CT ratio of our study was 4.21. The overall TP was 31.69% and the overall TI was 0.56. Conclusion: Implementation of MSBOS is helpful in achieving the goal of rational usage of blood. Based on the results, we grouped the surgical procedures which need type and screen, type and hold, and type and cross-match.

Maximum Surgical Blood Order Schedule (MSBOS) for Cardio - Thoracic &amp; Vascular Interventions in an Apex Tertiary Care Hospital of India

Maximum Surgical Blood Order Schedule (MSBOS) for Cardio - Thoracic &amp; Vascular Interventions in an Apex Tertiary Care Hospital of India

Predictive modeling to create a proactive approach to patient blood management in the oncology population.

332 Background: Patient safety concerns that arose during COVID-19, related to blood shortages at a large oncological transfusion center, foregrounded the need for predictive modeling tools to optimize blood product inventory control. A maximum surgical blood ordering schedule (MSBOS), is a tool used to assist clinicians in predicting intraoperative blood usage based on retrospective historical data within an institution. Although MSBOS proves to be valuable, it is rudimentary in nature. Not only is data collection cumbersome but the data generated may not reflect current surgical practices and inter-patient variability may skew procedural averages. Predictive blood modeling is contingent generation of a digital health dashboard (DHB). DHB are electronically embedded in the electronic health record (EHR) to collect perioperative data. Coupling the generated informatics (patient demographics, diagnosis, laboratory results, procedural type, medications/supplements, surgeon) with machine learning allows for creation of patient-centered predictive blood modeling algorithms and better inventory control. Methods: To characterize blood use across various procedures at our institution, we engaged information technology specialists to create a Web Intelligence report by integrating data from both an EHR and a lab information system (LIS) into a single repository. Information obtained illuminated a master procedure list, blood product usage patterns, and characterized patient demographics during January - March, 2020. Data is continuously extracted to create a perpetually updated MSBOS while secondarily functioning to cultivate data for future predictive machine learning algorithms. Results: Data analysis demonstrated 5598 procedures were performed during the first quarter of 2020. Procedures not transfused with packed red blood cells (pRBCs) totaled to 4,156 and 1,442 had a greater than or equal to 10% probability of requiring pRBCs. Our current practices reflected our overall crossmatch to transfusion ratio ( C:T) was 5.4 to 1. Concerted collaboration, resulting in preparation of pre-surgical blood product orders according laboratory generated MSBOS schedule could decrease the C:T to 1.7 to 1. Additionally, high intraprocedural pRBCs variability was identified in current procedural subtypes. Conclusions: Traditionally generated MSBOS are functionally limited and may not be reflective of current surgical practices. Additionally, inter-patient variability may distort some procedural type guidance. Creating an integrated data report, eliminates some of the inherent limitations of traditional MSBOS. Moving forward, the cultivated data if coupled with machine learning has the potential to create transferable proprietary algorithms that proactively predict individual patient transfusion needs.

Blood Transfusion Practice in Operating Rooms in Nemazee Hospital in Southern Iran.

The requests for blood products in elective surgeries exceed actual use, leading to financial wastage and loss of shelf-life. In this study, we assessed the blood transfusion indices in elective surgeries performed in the operating rooms. In this cross-sectional study, from January to June 2017, a total of 970 adult patients who underwent elective surgeries in the operating rooms of Nemazee hospital, a general referral hospital in southern Iran, were investigated. Demographic, clinical, and laboratory data, such as hemoglobin (Hb), hematocrit (Hct), platelets, prothrombin time (PT), and partial thromboplastin time (PTT) were gathered from medical records. Blood utilization was evaluated using the following indices: cross-match to transfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI), and Maximum Surgical Blood Order Schedule (MSBOS). The overall C/T, T%, and TI ratios were 2.49, 46.6%, and 0.83 for all procedures, and the highest and lowest ratios pertained to the thoracic and cardiac surgeries, respectively. The C/T ratio was ≥2.5 for all surgical procedures except for cardiac surgeries. T% was <30 for thoracic and orthopedics surgeries and ≥30 for other surgical procedures. In all surgical procedures, TI was less than 0.5, except for cardiac surgeries. Also, the MSBOS was about 3 units for cardiac surgeries and ranged from 0.5 to 1 units in other surgeries. The results of this study showed a high quality blood transfusion practice in cardiac surgeries, possibly due to more focus on this critical ward. Assessing difficulties in the process of reservation, utilization, and preparation of standard protocols and policies are required to improve the blood utilization practice in operating rooms.

Maximum surgical blood ordering schedule for cancer surgeries: An institutional study

Maximum surgical blood ordering schedule for cancer surgeries: An institutional study

Audit of blood utilization in a tertiary care hospital: Our experience over a period of 2 years

Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of >2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.

Surgical blood ordering schedule for better inventory management: An experience from a tertiary care transfusion center

BackgroundOverordering of blood has been a challenge faced by the blood bank staff. The present study addresses the role of maximum surgical blood ordering schedule (MSBOS) in optimizing the blood inventory management. MethodsThe blood requests for elective surgical procedures from various surgical departments were reviewed to constitute MSBOS. Transfusion profile was assessed using crossmatch to transfused units (C/T) ratio, transfusion probability (TP), and transfusion index (TI). A cutoff of 0.3 and 5% value of TI and TP, respectively, was considered to decide on the type of crossmatch. The efficacy of MSBOS implementation has been determined prospectively by unpaired t test using SPSS software, version 20 (IBM, USA). ResultsA total of 2674 patients were studied. Overall red cell usage rate was 15%. The comprehensive C/T ratio was 4.57. The C/T ratios for the various departments ranged from 1 to 8.5 (adjusted C/T ratio). Highest C/T ratio was observed for surgical procedures performed in the specialties of otorhinolaryngology and urology. A C/T ratio greater than 5 was noted in 30.4% of different types of surgical procedures. Of the 176 different types of elective surgical procedures studied, type and screen protocol was applicable for 75.5% (133) of the procedures. After implementation of MSBOS, the number of crossmatches reduced by 2152 and total working time saved in our laboratory is close to 75,320 man hours. ConclusionMSBOS helps in identifying the common surgical procedures with low TP and is one of the efficient tools in preventing the overordering of the blood.

Predictive model of preoperative blood preparation for transfusion in isolated coronary artery bypass graft surgery

<h3>Introduction</h3> Patients undergoing isolated coronary artery bypass graft (CABG) at our heart centre require two packed red blood cells (RBC) pre-operatively based on the data from Maximum Surgical Blood Order Schedule (MSBOS). Transfusion-related mortality and morbidity have been shown to be dose dependent, suggesting that the lowest effective number of units should be transfused. Pre-operative identification of patient's characteristic requiring blood transfusion during procedure will allow for better utilization of blood, reduce wastage and increase cost efficiency. We aim to define a set of parameters to indicate necessity for blood transfusion hence, consideration will be given to supply one instead of two packed RBC to patients who do not require transfusion. <h3>Methods</h3> This cross-sectional study obtained integrated data-set from the hospital information system and clinical database (Cardio thoracic Surgery Registry) from January 2015 to December 2018. A total of 4,646 patients who underwent isolated CABG were included in this study and 28 independent predictors associated with transfusion were identified and analyzed. A predictive model for preoperative requirement of blood transfusion was developed using logistic regression and machine learning approach ie; Decision tree, Logistic Regression, KNN, Naïve Bayes, Gradient Boosted Tree, and Random Forest using RapidMiner. <h3>Results</h3> In 2015-2018, only 25.7% of patients utilized two packed RBC's whereas 20.2% utilized only one for blood transfusion during procedure. The remainder 54.1% of non-utilized blood were returned to the blood bank within 48 hours. Logistic regression and machine learning algorithm unveiled similar significant predictors to predict the requirement of blood transfusion pre-operatively. There are 24 significant predictors identified from the highest accuracy algorithm which is Random Forest (99.78%), as compared to others machine learning approaches particularly the Decision Tree 79.55%, Logistic Regression 85.25, KNN 75.35%, Naïve Bayes 79.76%, and Gradient Boosted Tree 83.32%. <h3>Discussion</h3> A clinical predictive model was developed for preoperative risk stratification of patients requiring blood transfusion and to further assist clinicians for better utilization of blood bank resources. Variables significantly associated with blood transfusion were female gender, EF<50%, BMI<30, age>40 serum creatinine>100mmol/L, and previous cardiac procedures. This tool may prospectively optimize the ordering of blood with the potential to reduce adverse events and costs related to transfusion in the future. However, for the consideration to supply only one packed RBC in retrospect to patients who do not require transfusion, more data and predictors should be added in this study.