AB217. SOH25_AB_115. Cross-matching in spinal surgery: an audit on compliance with the maximum surgical blood order schedule

Background: The Mater Misericordiae University Hospital (MMUH) is the national spinal injury centre. It conducts a large volume of spinal surgeries in Ireland, necessitating a substantial volume of blood products. The objective of this audit was to assess the units of red cell concentrate (RCC) cross-matched for each spinal surgery in MMUH and compare it to the maximum surgical blood order schedule (MSBOS) standard.

Methods: We conducted a retrospective audit of all spinal surgeries for the month of October 2024 in MMUH. We assessed how many units of RCC were cross-matched for each patient and compared this to the MSBOS.

Results: There were a total of 63 spinal surgeries in October. There was an excess of 58 units of RCC available intra-operatively when compared to the standard. Each unit costs €339 resulting in an overspend of €19,662 on over-subscribed RCC for the month of October. In total, 43% (n=27) of patients had excessive units crossmatched, 52% (n=33) had the correct amount and there were only three cases where the number of RCC requested pre-op was under the recommended amount. No case required further units to be ordered or crossmatched intra-operatively.

Conclusions: This audit demonstrates the lack of compliance with the MSBOS standard. Furthermore, there is a need for a more comprehensive guideline in the National Spinal Injuries Unit which accounts for the variety of surgeries carried out and avoids over burdening our blood transfusion service. Following instigation of this new guideline a second stage audit will evaluate the effect.

Keywords: Audit; compliance; crossmatch; spine; surgery