Routine Group-and-Save (G+S) Testing Prior to Laparoscopic Appendectomy: A 10-Year Single-Centre Review

Area of Science:

• Surgical Oncology
• Transfusion Medicine
• Health Economics

Background:

• Routine preoperative group-and-save (G+S) testing is widely practiced before laparoscopic appendectomy in the UK.
• Evidence supporting the necessity of G+S in this patient population is limited.
• This study investigates the clinical utility and cost-effectiveness of G+S in laparoscopic appendectomy over a decade.

Purpose of the Study:

• To evaluate the clinical need for routine preoperative group-and-save (G+S) testing in patients undergoing laparoscopic appendectomy.
• To assess the cost-effectiveness of G+S testing in this surgical context.
• To determine the rate and causes of perioperative blood transfusions in laparoscopic appendectomy patients.

Main Methods:

• A 10-year retrospective cohort study of 1,733 patients undergoing laparoscopic appendectomy.
• Analysis of electronic records to identify perioperative transfusions and their indications (surgical vs. non-surgical).
• Comparison of transfusion rates with published literature and cost analysis of routine G+S testing.

Main Results:

• Only 0.29% of patients received transfusions, with just 0.12% due to postoperative surgical bleeding.
• Most transfusions were for non-surgical reasons, such as underlying medical conditions.
• Routine G+S testing for all patients incurred substantial costs (£26,000-£36,500) with minimal clinical yield.

Conclusions:

• Routine preoperative G+S testing offers minimal clinical benefit for low-risk patients undergoing laparoscopic appendectomy.
• The practice represents an unnecessary use of healthcare resources.
• A selective, risk-based approach to G+S testing is recommended to optimize patient safety and reduce costs.