AB173. SOH21AS183. Audit on blood ordering requests in mastectomies: the need for a routine group and hold

Background: A group and hold (G&H) forms part of the pre-transfusion compatibility testing and is commonly requested in anticipation of a possible blood transfusion. Requests made in the context of elective procedures with a low transfusion probability, such as a mastectomy, are associated with added financial burden and increases workload in a health system. This audit aims to analyse the cost-benefit associated with the routine request for a preoperative G&H in patients undergoing mastectomies

Methods: A total of 100 patients undergoing mastectomies from the period of September 2019 to October 2020 were included in the audit. Data regarding blood order requests, units of blood transfused, perioperative haemoglobin and the type of mastectomy (right, left or bilateral) were collected.

Results: All patients had a routine G&H as part of their preoperative assessment. The average age in this cohort was 60.3 years (range, 30–89 years). Right-sided mastectomy was the commonest procedure (n=52). The mean (SD) preoperative haemoglobin was 13.0 (1.4) g/dL. Only 15% of the cohort had a post-operative haemoglobin level checked. The mean (SD) drop in haemoglobin was 2.3 (1.5) g/dL. 2/100 patients received post-operative blood transfusions, translating into a transfusion probability of 2%.

Conclusions: This audit demonstrates the low prevalence of blood transfusions in patients undergoing mastectomies, consistent with current literature. The projected cost savings associated with selective requests for G&H are significant. Moving forward, large prospective studies are required to develop validated scoring systems for the implementation of a safe and targeted blood ordering approach in patients with a high risk of bleeding.

Keywords: Mastectomy; blood transfusion; blood loss; breast surgery; haemovigilance; group and hold