Efficiency of Blood Utilization in Elective Neurosurgery Patients and Development of a Maximum Surgical Blood Order...

Objectives Primary Objective  To evaluate the efficiency of perioperative blood utilization in elective neurosurgical procedures using the crossmatch-to-transfusion (C/T) ratio, transfusion probability (TP), and transfusion index (TI). Secondary Objective  To develop procedure-specific maximum surgical blood ordering schedules (MSBOS) using Mead's criteria, categorizing procedures according to the need for no routine preoperative blood preparation, type-and-screen (T&S) only, or preoperative crossmatching, and to determine the recommended number of packed cell volume (PCV) units for procedures requiring crossmatching. Materials and methods A descriptive cross-sectional study was conducted over six months at a tertiary care hospital. A total of 142 patients (100%) undergoing elective neurosurgical procedures were included. Details of blood grouping, cross-matching, and blood transfusion were recorded for each patient. Blood utilization was assessed using the C/T ratio, TP, and TI, and the MSBOS was formulated according to Mead's criteria. Statistical analysis The C/T ratio, TP, and TI were calculated using standard formulae. The MSBOS was derived using the formula MSBOS = 1.5 × TI to recommend the appropriate number of preoperative blood units for elective neurosurgical procedures. Results Blood grouping and cross-matching were performed in 136 (95.7%) and 135 (95.4%) patients, respectively. Blood transfusion was required in 29 patients (20.4%), with 44 units transfused. The overall C/T ratio was 9.1, while the TP and TI were 22.3% and 0.33, respectively, indicating inefficient blood utilization. Relatively efficient blood utilization was observed in spinal tumour surgery, aneurysm clipping, and meningioma resection. Based on the calculated MSBOS, one unit of packed red blood cells (PRBCs) was recommended for laminectomy, spine fixation, spinal tumour surgery, aneurysm clipping, and posterior fossa surgery, whereas two units were recommended for meningioma resection. Conclusions Blood utilization in elective neurosurgical procedures was inefficient. Implementation of a procedure-specific MSBOS may reduce unnecessary cross-matching, optimize blood resource utilization, and improve transfusion practices in neurosurgical patients.