Removing the need for crossmatched blood in elective EVAR

Area of Science:

• Vascular Surgery
• Transfusion Medicine
• Health Economics

Background:

• The cost of crossmatching blood is significant (£137.22 per unit).
• A standardized maximum surgical blood order schedule for elective endovascular aneurysm repair (EVAR) is lacking.
• High crossmatch to transfusion (C:T) ratios can lead to unnecessary blood wastage and increased costs.

Purpose of the Study:

• To determine the crossmatch to transfusion ratio for elective EVAR.
• To establish a recommendation for a maximum surgical blood order schedule for elective EVAR.
• To assess the feasibility of using a type and screen protocol for elective EVAR.

Main Methods:

• A retrospective study of 203 consecutive elective EVAR cases from October 2001 to December 2010.
• Analysis of blood loss, units transfused, and indications for transfusion.
• Calculation of the crossmatch to transfusion ratio.

Main Results:

• Median blood loss was 200 ml (mean 288 ml).
• Only 6% of patients required blood transfusion, with most transfusions for postoperative low hemoglobin or medical complications.
• The crossmatch to transfusion ratio was 11.1, indicating a high rate of crossmatched blood units not transfused.

Conclusions:

• A 'group and save' (type and screen) protocol is recommended for elective EVAR due to the high C:T ratio.
• Intraoperative transfusions are infrequent (<1%) but can be massive, necessitating emergency protocols.
• Implementing this strategy can lead to significant financial savings, improved efficiency, and reduced blood wastage across surgical specialties.