Maximum surgical blood order schedule: A key component of perioperative blood management in neurosurgery

Institute specific protocols are needed to reduce unnecessary cross matches. Type and screen policies for surgical procedures which does not require blood and maximum surgical blood order schedule (MSBOS) for procedures which require blood units are the two protocols in use currently.

To compare the effect of maximum surgical blood order schedule in neurosurgery between pre- and post-implementation.

It is a study of 5 years' duration (4 years retrospective and 1 year prospective) conducted at the departments of transfusion medicine, neurosurgery and neuroanesthesia.

The patients above 18 years for whom blood requisition were sent were included, whereas those who underwent emergency procedures, massive transfusion, or had underlying bleeding disorders were excluded. The MSBOS was developed based on 4 years' retrospective data and the new protocol was followed for 1 year. The transfusion indices were compared between preimplementation and postimplementation.

A total of 2462 patients were included in the retrospective period, whereas it was 746 in the prospective group. Overall, reduction of crossmatch to transfused ratio from 3.6 to 2.4 and increase of blood utilization from 27.40% to 41.55% was observed. The patients for whom type and screen were performed increased from 18% in the retrospective period to 75% in the prospective period. Eighteen out of 30 common procedures were managed with T and S and seven of them did not require even a single unit of red blood cells intraoperatively.

Our study highlights the importance of including both diagnosis and procedure to formulate MSBOS and the use of modified formulas "transfusion index for type and screen and transfusion probability for type and screen" for revision of MSBOS.