Preoperative "group and save" in lumbar microdiscectomy: is it necessary?

"Group and save" (type and screen) is commonly requested preoperatively in lumbar microdiscectomy. On average, less than 100 ml of blood is lost during lumbar microdiscectomy, and blood transfusion guidelines and resuscitation practice recommend that no transfusion would be required in almost all healthy patients with less than 750 ml of blood loss. The authors performed an audit of 319 consecutive lumbar microdiscectomies to determine if the practice of group and save can be justified. A telephone survey of the United Kingdom (UK) neurosurgical units to establish current UK neurosurgical practice was also conducted.

A telephone survey of all UK neurosurgical units and an audit of all patients who underwent primary lumbar microdiscectomy at our institution over a period of 2 consecutive years was performed. The health records of all patients were retrieved and critically reviewed. Information about hemoglobin measurements before and after surgery, group and save, and blood transfusion were collected.

Thirty-two UK neurosurgical units were surveyed by telephone, with a 100% response rate. Group and save was commonly performed prior to lumbar microdiscectomy in 28 units (87.5%). The records of 319 consecutive patients who underwent lumber microdiscectomy were reviewed. All patients had group and save prior to lumbar microdiscectomy. No patient required a blood transfusion during or after surgery. The mean decrease in hemoglobin concentration was 0.8 g/dl in 121 patients who had postoperative hemoglobin measurements.

Blood transfusion and hemoglobin decrease following lumbar microdiscectomy is exceptionally rare. Group and save and postoperative hemoglobin measurements are therefore nonessential in all patients undergoing lumbar microdiscectomy, with potentially significant cost savings from not performing these tests.