Finlayson Calvin R, Hamilton Steven W
Trauma and Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, GBR.
Cureus. 2024 Nov 19;16(11):e74009. doi: 10.7759/cureus.74009. eCollection 2024 Nov.
Background Fractures of the peripheral limbs make up a significant proportion of the caseload seen by an Orthopaedic Department. Some of these fractures will require surgical intervention and typically undergo open reduction and internal fixation (ORIF). Current guidance states that patients undergoing such procedures do not require group and save testing prior to theatre. Despite this, many patients still undergo these tests, which are seldom utilised to facilitate intraoperative or postoperative transfusion. Aim This article sets out to determine the incidence of group and save testing performed within a tertiary trauma service, as well as the rate of transfusions observed and any potential relationship with pre-operative haemoglobin as a predictor of transfusion. The financial cost of performing group and save tests, outwith current guidance, will also be determined to assess the financial impact on the trust. Methodology A three-month retrospective cohort analysis was conducted, utilising theatre planning records from June 1, 2024, to August 31, 2024, to identify patients undergoing single-procedure ORIFs of the forearm, wrist, hand, ankle or foot. Each patient's electronic patient record was then examined to determine age, sex, pre-operative haemoglobin concentration, number and date of group and save tests, and whether they were issued or received blood products. The individual cost of one group and save test was found through enquiry with the local blood transfusion laboratory as £10.77. Results There were 117 patients who underwent 118 distal limb ORIFs and a total of 105 group and save samples sent. The mean pre-operative haemoglobin was 132.5 g/L, with a minimum observed haemoglobin of 94 g/L. No patient received blood products intraoperatively or postoperatively. The total cost of group and save testing in the period observed was found to be £1,130.85. The projected annual cost of the group and save testing for this cohort was £4,523.40. Conclusion This study finds that, despite local and national guidance, a significant number of group and save tests are being conducted unnecessarily, at significant cost to the trust. There is no relationship observed between pre-operative haemoglobin and transfusion requirement, which confirms that current guidance is appropriate. Increasing adherence to current policy is projected to save the trust up to £4,523.40 annually. It is recommended that other centres audit their use of pre-operative testing for appropriateness, utility and cost.
背景 四肢外周骨折在骨科科室的病例量中占相当大的比例。其中一些骨折需要手术干预，通常采用切开复位内固定术（ORIF）。目前的指南指出，接受此类手术的患者在进入手术室前不需要进行血型鉴定和交叉配血试验。尽管如此，许多患者仍然接受这些检查，而这些检查很少用于术中或术后输血。目的 本文旨在确定在三级创伤服务机构中进行血型鉴定和交叉配血试验的发生率，以及观察到的输血率，以及与术前血红蛋白作为输血预测指标之间的任何潜在关系。在现有指南之外进行血型鉴定和交叉配血试验的财务成本也将被确定，以评估对信托基金的财务影响。方法 进行了为期三个月的回顾性队列分析，利用2024年6月1日至2024年8月31日的手术室规划记录，确定接受前臂、腕部、手部、踝部或足部单手术ORIF的患者。然后检查每位患者的电子病历，以确定年龄、性别、术前血红蛋白浓度、血型鉴定和交叉配血试验的次数和日期，以及他们是否发放或接受了血液制品。通过向当地输血实验室询问，发现一次血型鉴定和交叉配血试验的个人成本为10.77英镑。结果 有117名患者接受了118例肢体远端ORIF手术，共送检了105份血型鉴定和交叉配血样本。术前平均血红蛋白为132.5 g/L，观察到的最低血红蛋白为94 g/L。没有患者在术中或术后接受血液制品。在所观察期间，血型鉴定和交叉配血试验的总成本为1130.85英镑。该队列的血型鉴定和交叉配血试验预计年度成本为4523.40英镑。结论 本研究发现，尽管有地方和国家指南，但仍有大量不必要的血型鉴定和交叉配血试验在进行，给信托基金带来了巨大成本。术前血红蛋白与输血需求之间未观察到相关性，这证实了当前指南是合适的。预计增加对现行政策的遵守每年可为信托基金节省高达4523.40英镑。建议其他中心审核其术前检查的使用是否适当、实用和成本效益。
