Is group and save still a necessary test in the preoperative workup for breast cancer surgery?

Trust guidelines state that patients undergoing mastectomy have one group and save (G&S) sample preoperatively, or two for bilateral or complex mastectomy. Breast surgical patients rarely require blood transfusion, and G&S testing is costly and labour intensive. Our study assessed whether preoperative G&S testing is warranted for breast surgery patients.

Retrospective review of consecutive patients undergoing mastectomies from one centre, from June 2018 to June 2019 identified 190 women. Review of electronic records for G&S tests was performed and transfusions prescribed. Discussion with laboratory personnel regarding costs of processing G&S tests.

Forty-six (32%) patients who underwent simple mastectomies had one G&S, eight (6%) patients had two. Twenty (45%) patients who underwent bilateral/complex mastectomy/reconstruction had one G&S and four (9%) had two. No patients required peri or postoperative blood transfusions. Seventy-eight G&S tests performed cost the trust £1,082.

Simple mastectomies rarely require blood transfusions. G&S tests cost £13.83 and are time consuming for the patient and laboratory. We propose that G&S tests are unnecessary for patients undergoing simple mastectomies and preoperative protocols require adjustment. Trust policy is to have 'routine G&S'; however, 124 patients did not have any G&S testing. Had the guideline been followed, this would have cost the Trust a further £1,715.