Cutting Costs and Carbon: Re-evaluating Routine Group and Save Testing for Appendicectomies

Area of Science:

• Surgical Oncology
• Healthcare Management
• Clinical Pathology

Background:

• Routine preoperative Group and Save (G&S) testing is standard practice before appendicectomy to ensure blood availability.
• Transfusion rates in appendicectomy are exceedingly rare, questioning the necessity of routine G&S testing.
• The study evaluates the clinical utility, cost, and environmental impact of G&S testing in the context of sustainable healthcare.

Purpose of the Study:

• To re-evaluate the necessity of routine preoperative Group and Save (G&S) testing for appendicectomy.
• To analyze the clinical utility, financial cost, and environmental impact of G&S testing.
• To determine if a selective, risk-based testing strategy is more appropriate.

Main Methods:

• Retrospective review of 265 appendicectomies at Pinderfields Hospital.
• Data collected included demographics, American Society of Anesthesiologists (ASA) grade, white cell count (WCC), and C-reactive protein (CRP).
• Statistical analysis included t-tests and chi-square tests; financial and carbon footprint estimates were calculated.

Main Results:

• No intraoperative or immediate postoperative transfusions occurred (0% transfusion rate).
• Complicated appendicitis cases showed significantly higher WCC, CRP, and patient age.
• Routine G&S testing incurred an estimated annual cost of £14,116 and a carbon footprint of 190.06 kg CO₂e.

Conclusions:

• Routine preoperative G&S testing for appendicectomy offers negligible clinical benefit and incurs significant financial and environmental costs.
• Elevated inflammatory markers, higher ASA grades, and older age predict complicated appendicitis, supporting a selective testing strategy.
• Restricting G&S testing to higher-risk patients can enhance efficiency and contribute to National Health Service (NHS) sustainability goals.