Preoperative Group and Save Tests in Elective and Emergency Cholecystectomies: An Economic and Environmental Burden

Background and objective Cholecystectomy is among the most frequently performed elective day-case surgeries in the UK, with a growing emphasis on same-day discharge. Although perioperative bleeding and the need for blood transfusion are uncommon with this procedure, routine group and save (G&S) testing is frequently performed for cholecystectomy, contributing to both a significant economic and environmental burden. This study aimed to assess the proportion of patients undergoing cholecystectomy who had preoperative G&S testing and to identify how many required a perioperative blood transfusion. Methods This study involved a retrospective analysis of 755 consecutive adult elective or emergency cholecystectomy procedures performed over a two-year period between August 2022 to 2024 in a North West England NHS trust. Patients were assessed from admission through to discharge. Data collected included American Society of Anesthesiologists (ASA) grade, surgical urgency, the number of preoperative G&S tests performed, and the incidence of perioperative red cell transfusion. Results Our cohort included 755 patients: 728 (96.4%) underwent total cholecystectomy, with 27 (3.6%) having associated cholecystectomy procedures. Seven hundred (92.7%) patients had an elective procedure, while 55 (7.3%) underwent an emergency cholecystectomy. The mean patient age was 49 years. Of the cohort, 159 patients (21%) were classified as ASA grade 1, 491 (65%) as ASA grade 2, and 105 (14%) as ASA grade 3. A total of 1,422 G&S samples were submitted for this cohort; 481 patients (64%) had two samples taken, while 92 patients (12%) had more than two G&S tests performed. Only one patient required a red cell transfusion, and two patients required a return to theatre due to anaemia secondary to haemorrhage. Conclusions Our findings suggest that routine preoperative G&S testing is not required in cholecystectomy, given the paucity of blood product transfusions. Unnecessary G&S testing costs our trust approximately £24,000 and consumes around 2,480 hours of laboratory time. This practice also imposes a considerable financial and environmental burden due to greenhouse gas emissions associated with the testing process. A more selective and stratified approach to G&S testing in cholecystectomy may prove beneficial in economic terms and work in synergy with the goal of improving sustainability in the NHS.