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Maximum Surgical Blood Ordering Schedule in Common Pediatric Cardiac Surgeries in a Tertiary Center
Maryam Sotoudeh Anvari1, Seyedeh Zohreh Hashemi2, Mohammadreza Mirzaaghayan3
1Department of Surgical and Clinical Pathology, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
This study developed a Maximum Surgical Blood Order Schedule (MSBOS) for pediatric cardiac surgery to optimize red blood cell (RBC) use. Implementing an accurate MSBOS reduces waste and improves patient safety by preventing unnecessary pre-operative blood orders.
Area of Science:
- Transfusion Medicine
- Pediatric Cardiac Surgery
- Health Services Research
Background:
- Unnecessary pre-operative ordering of red blood cells (RBCs) in elective surgeries leads to increased costs and blood inventory waste.
- The Maximum Surgical Blood Order Schedule (MSBOS) is a strategy to estimate blood needs and prevent overconsumption.
Purpose of the Study:
- To design and establish an MSBOS specifically for pediatric cardiac surgeries.
- To optimize the use of blood products and reduce wastage in pediatric cardiac procedures.
Main Methods:
- A cross-sectional study was conducted on 205 pediatric patients undergoing elective cardiac surgery.
- Data on transfused and cross-matched blood units were collected to calculate the cross-match to transfusion ratio (CTR), transfusion index (TI), and transfusion probability (T%).
Main Results:
- Overall, 410 RBC units were cross-matched, and 262 were transfused, resulting in an overall CTR of 1.56, T% of 76%, and TI of 1.28.
- Specific MSBOS values were determined for various pediatric cardiac surgeries, including ventricular septal defect (1.58) and tetralogy of fallot (1.03).
Conclusions:
- Accurate MSBOS protocols are crucial for reducing laboratory cross-match workload.
- Implementing MSBOS leads to appropriate blood stock utilization, less wastage, conservation of resources, and enhanced patient safety.
Background & Objective:
Unnecessary pre-operative ordering of red blood cells (RBCs) in elective surgeries increases costs and waste of blood inventory. Maximum surgical blood order schedule (MSBOS) is a helpful strategy in the estimation of blood units needed for surgery and the prevention of overconsumption. In this study, an MSBOS for pediatric cardiac surgeries is designed.
Methods:
In this cross-sectional study, we included all pediatric patients who underwent elective cardiac surgery in Children's Medical Center in Tehran, Iran, from March 21, 2019, to September 22, 2019. Data consisted of the type of surgery and the number of blood units transfused and units cross-matched, based on which cross-match to transfusion ratio (CTR), the transfusion index (TI), and transfusion probability (T%) were calculated.
Results:
Overall 205 pediatric patients were included in the study. Four hundred and ten RBCs units were cross-matched, and 262 were transfused. The overall results of the CTR, T%, and TI for all the eight types of cardiac surgery were 1.56 (410/262), 76% (157/205), and 1.28 (262/205), respectively. The raw MSBOS for cardiac surgeries included ventricular septal defect, tetralogy of fallot, dextro-transposition of the great arteries, atrial septal defect, aortic coarctation, patent ductus arteriosus, pulmonary stenosis, and pacemaker insertion, which were 1.58, 1.03, 1.54, 1.66, 0.77, 0, 1.25, and 0 unit, respectively, and the figures were rounded up.
Conclusion:
Accurate MSBOS protocols reduce cross-match workload in laboratories, lead to the appropriate use of blood stocks with less wastage, save human and economic resources, and eventually, promote patient safety.
