Factors contributing to red blood cells crossmatch, transfusions, and outcomes among surgical patients in Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia

BACKGROUND: Blood transfusion is widely used to manage anemia, but excessive blood ordering contributes to financial loss, higher hospital costs, and avoidable transfusion risks. Although the maximum surgical blood ordering schedules (MSBOSs) aim to optimize utilization, overordering remains common in surgical practice. AIMS: This study evaluates the crossmatch-to-transfusion (C: T) ratio among surgical patients and identifies demographic and clinical factors such as gender, age, admission type, comorbidities, hemoglobin on admission, and estimated blood loss that influence crossmatch requests and transfusion. It also examines outcomes, including hospital stay, rebleeding, readmission, discharge hemoglobin, and mortality between transfused and nontransfused patients. METHODOLOGY: A retrospective, cross-sectional study, noninterventional study was conducted at Hospital Raja Perempuan Zainab II using records of 419 patient’s data from January until December 2022. Systematic sampling was applied, and data were extracted from patient’s medical record, transfusion request forms, and the blood bank information system. Descriptive and multivariate analyses assessed demographics and clinical factors, whereas binary logistic regression identified predictors of transfusion outcomes. RESULTS: Of crossmatch requests, 52.3% were from male patients and 50.8% from those >60 years. The overall C: T ratio was 1.42. Significant associations with transfusion ( P < 0.001) included age >60, emergency admission, and admission hemoglobin of 7–10 g/dL. Transfused patients had higher rebleeding rates ( P = 0.05), longer hospital stays (~12 days), lower discharge hemoglobin (8.85 g/dL), and higher mortality, but no significant difference in readmissions. CONCLUSION: The study demonstrates relatively appropriate blood use with a C: T ratio of 1.42, but highlights the need for further optimization. Elderly males and emergency cases were more likely to require transfusion. Outcomes suggest that transfusion alone does not improve prognosis without addressing underlying risks. Strengthening adherence to MSBOS and implementing structured patient blood management may reduce unnecessary crossmatching and enhance surgical care.