Are blood group and save samples needed for cholecystectomy?

BACKGROUND

Cholecystectomy is a common, safe procedure. This study aimed to determine whether a blood group and save approach still is required for primary cholecystectomy.

METHODS

A retrospective regional analysis of all cholecystectomy patients identified from pathology records between January 1998 and February 2005 was undertaken. The study excluded from further analysis patients for whom cholecystectomy was not the primary operation or for whom the data were incomplete.

RESULTS

A total of 4,652 patients were identified. Of these patients, 19 were excluded due to incomplete data and 171 were excluded because the cholecystectomy was secondary to another procedure. Of the remaining 4,462 patients, 2,916 (65.4%) had a blood sample sent to the blood transfusion service. The 2,916 patients were subdivided into blood group and save samples (2461/4462, 55.2%) and blood cross-matched samples (455/4462, 10.2%). Blood transfusion was required by 48 patients (48/4462, 1.1%). Subanalysis of the transfused group showed that 27 patients received a blood transfusion due to complications of the index operation, with 18 (18/27, 66.7%) undergoing transfusion while in the operating theater. The indication for transfusion in the remaining 21 patients was secondary to a reoperation for complications of laparoscopic cholecystectomy (n = 8), related to primary hematologic malignancy (n = 6), or not documented (n = 7).

CONCLUSION

The use of routine blood group and save is not justified. A targeted approach will reduce the demand on blood transfusion service without detriment to those undergoing cholecystectomy. There is no substitute for adequate vigilance for bleeding as a complication with any surgical procedure.