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Are blood group and save samples needed for cholecystectomy?
Martha Quinn1, Stuart Suttie, Alan Li
1Department of Surgery, Gartnavel General Hospital, Glasgow, G12 0XH, UK. martha.quinn@doctors.org.uk
Insights
Routine blood group and save procedures are not necessary for primary cholecystectomy. A targeted approach to blood transfusions reduces demand on services without harming patients undergoing gallbladder removal.
Area of Science:
- Surgical Procedures
- Transfusion Medicine
- Patient Safety
Background:
- Cholecystectomy is a frequently performed and generally safe surgical procedure.
- The necessity of routine blood group and save protocols for primary cholecystectomy has been questioned.
Purpose of the Study:
- To evaluate the requirement for routine blood group and save procedures in primary cholecystectomy.
- To assess the impact of current transfusion practices on patient outcomes and blood service demand.
Main Methods:
- Retrospective analysis of cholecystectomy patients from pathology records (January 1998 - February 2005).
- Exclusion of patients with secondary operations or incomplete data.
- Categorization of blood sample handling: blood group and save vs. cross-matched.
Main Results:
- Out of 4,462 eligible patients, 1.1% (48) required blood transfusion.
- Transfusions were primarily due to operative complications (66.7% in the operating theater) or reoperations.
- Routine blood banking was performed for 55.2% of patients, while cross-matching was done for 10.2%.
Conclusions:
- Routine blood group and save is not justified for primary cholecystectomy.
- A targeted transfusion approach can decrease demand on blood transfusion services.
- Vigilance for surgical bleeding remains paramount, regardless of transfusion protocols.
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.