AB202. SOH21AS112. The economic use of peri-operative blood products in spinal surgery

Background: The Maximum Surgical Blood Ordering Schedule (MSBOS) is the local guideline used in Irish hospitals. Our MSBOS in Galway University Hospital (GUH) states that for each single level lumbar spine decompression, a pre-operative patient should be cross-matched for 2 units red cell concentrate (RCC). The MSBOS of the Mater Misericordiae University Hospital (MMUH) was utilised as the audit standard (Group and Save only). We aim to quantify current practice and determine saving to the blood bank.

Methods: A sample of 35 patients who underwent single level lumbar spine decompression, over a period of 13 months was obtained and their pre-operative blood saving sample recorded using the blood bank computer system. This data was analysed using Statistical Package for the Social Science (SPSS). These results were discussed with all relevant stakeholders.

Results: 13/35 of these patients (37.1%) were Group and Held only. 16/35 of these patients (45.7%) were cross-matched for 2 units RCC (current guideline). One patient (2.8%) was cross-matched for 1 unit RCC. 4/35 (11.4%) patients were cross-matched for 4 units RCC. One patient (2.8%) had no crossmatch or Group and Hold carried out due to an incorrectly completed request form. Two of these 35 patients (5.6%) were transfused post-operatively.

Conclusions: The current guideline to group and crossmatch 2 units RCC for all single level lumbar spine decompressions is oftentimes not adhered to in practice. The Orthopaedic department and the blood bank in UHG have decided, after audit, that all single level spinal lumbar decompressions will now undergo routine Group and Hold.

Keywords: Cross-match; group and hold; group and save; red cell concentrate (RCC); lumbar decompression; peri-operative; spinal surgery; maximum surgical blood ordering schedule