Key result
Routine blood group and antibody screening for emergency appendicectomy was associated with a transfusion rate of only 0.2%, suggesting crossmatching as required could save the NHS up to £1.1M.
Why the study?
Many patients undergo group and antibody screening due to perceived hemorrhage risk despite low transfusion rates, and the cost-effectiveness of this screening versus crossmatching where required needed to be determined.
Does crossmatching where required instead of routine blood group and antibody screening reduce costs in patients undergoing emergency appendicectomy?
Observational (n=645)
No
Does crossmatching where required instead of routine blood group and antibody screening reduce costs in patients undergoing emergency appendicectomy?
Routine blood group and antibody screening for emergency appendicectomy is not cost-effective given the 0.2% transfusion rate, and crossmatching only when required could yield significant savings.
Routine screening may be unnecessary at 0.36% transfusion rate; leaves open cost-effectiveness of selective crossmatching in emergency laparoscopy.
The rate of transfusion associated with emergency laparoscopic general surgery has been shown to be 0.36%. A significant number of patients undergo group and antibody screening due to perceived risk of hemorrhage. All NHS hospitals have massive transfusion policies with immediate availability of O-negative blood. Blood group and antibody screening carries a cost of 35. The aim of this study was to determine the cost-effectiveness of group and antibody screening vs crossmatching where required. Materials and methods: All patients undergoing emergency appendicectomy over a 3-year period were retrospectively identified. The transfusion service then identified whether blood had been issued. Results: A total of 645 emergency appendicectomies were identified: 603 were laparoscopic and 42 open. One (0.2%) patient received a transfusion of 2 units. Discussion: Our study has shown a rate of transfusion of 0.2%. If patients were crossmatched as required rather than group and screening, this would give a cost saving of 35 per patient or 22345 across our trust. There are 50,000 appendicectomies per year in the United Kingdom. If this saving were extrapolated, it would generate a saving of 1.1M. Conclusion: Our recommendation would be to crossmatch where required. The cost saving to the NHS could be up to 1.1M with little impact on the demand for O-negative blood.
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Farrell et al. (2020) conducted an observational in Emergency appendicectomy (n=645). Routine blood group and antibody screening vs. Crossmatching where required was evaluated on Blood transfusion. Routine blood group and antibody screening for emergency appendicectomy was associated with a transfusion rate of only 0.2%, suggesting crossmatching as required could save the NHS up to £1.1M.
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