MTP8.05 Cutting the Cost, Not Safety; Evaluating Routine Pre-Operative G&S Testing in Emergent Laparoscopic Appendectomy

This project aimed to assess the necessity of routine G&S testing in emergent laparoscopic appendectomy and justify if it is safe to eliminate it only for high-risk patients. We have retrospectively investigated 103 emergent laparoscopic appendectomies that were performed over 6 months (October 2023- April 2024). 95 patients had pre-operative G&S, yielded 190 samples. Curiously; None of these were utilized for blood transfusion, whether pre-, intra-, or postoperatively. Each G&S test costs £18, resulting in a total allocation of £3,420 on tests with no utility. This has highlighted the perspective of a significant cost-saving project. Published studies by the Royal College of Surgeons (2020), BJS (2021, 2022), and many others, collectively agreed and concluded the safe elimination of routine testing in low-risk populations, all reported low risk of major bleeding that required resuscitation with blood transfusion specifically with the open technique for the first port which is the standard practice in our hospital. These studies promote advocating the G&S testing for only patients with remarkable risk factors or anticipated surgical challenges. Our proposed case-specific protocol relies on identifying the high-risk patients and justifying the requirement of preoperative G&S. In alignment with the evidence-based practice, patients fall in the high-risk category if there is one of the following risk factors; pre-existing anemia, ASAIII, or above, coagulopathies, anticoagulant therapy, or anticipated surgical complexity. An early collaboration between the surgical and anesthetic teams. This project demonstrates the capacity of significant financial savings without impacting patient care safety.