Reassessing the Necessity of Group and Save Testing in Ambulatory Orthopedic Peripheral Limb Trauma Surgery

Preoperative group and save (G&S) testing is routinely ordered for patients undergoing ambulatory peripheral limb orthopedic trauma procedures due to anticipated perioperative blood loss. However, national and local guidance on this protocol is often ambiguous, leading to potentially unnecessary testing with associated economic and environmental costs.​ This study aimed to determine the incidence of red cell transfusion in adult patients undergoing ambulatory peripheral limb trauma surgery, quantify the prevalence of preoperative G&S testing, and identify patient and procedural factors associated with the ordering of G&S tests.

This retrospective cohort study included all adult patients undergoing ambulatory orthopedic procedures (open reduction internal fixation and K-wire surgeries) distal to the shoulder and knee joints at a single NHS trust over a 12-month period (July 2024-July 2025). Data collected included patient demographics, incidence of G&S testing, and perioperative red cell transfusion rates. Statistical analysis used univariable and multivariable models to identify predictors of G&S testing.

A total of 459 patients (mean age 50.4+/-19.5 years), 157 (34.3%) had a G&S test performed, resulting in a total of 315 samples. The ankle was the site with the most frequent G&S testing (n=43, 62.6% of ankle procedures). American Society of Anaesthesiologists (ASA) grade 2 was the most frequent ASA grade (n=227, 49.5%). Mean preoperative hemoglobin was 132.1±18.3 g/L. One patient (0.21%) received a preoperative transfusion for pre-existing anemia. No patients received a postoperative red cell transfusion. Multivariable logistic regression found no clinical significance between demographics and the likelihood of G&S testing. Poisson regression analysis found that upper limb procedures were associated with significantly fewer tests (incidence rate ratio (IRR)=0.20, p=0.009), while higher ASA grade (p=0.024) and procedures involving the humerus/shoulder (IRR=3.0, p=0.037) were associated with increased G&S testing.

This study demonstrates that routine preoperative G&S testing is not clinically required for many patients undergoing ambulatory peripheral limb orthopedic trauma surgery. Current testing practices, influenced by procedural site and patient comorbidity (ASA grade), contribute to a significant and unnecessary economic and environmental cost. Implementing a selective, risk-based institutional protocol is necessary to align practice with evidence, improve cost-effectiveness, and enhance the sustainability of orthopedic surgical care.