Martin V. H. Rutten, Peter L. Houweling, Ivar Siccema, M.W.Hollmann
Background: In most hospitals the preoperative decision to determine blood type and screen (TS) is based on historical rules. With the use of hospital information systems, the incidence of perioperative blood transfusions could be used to guide the decision to TS or not. Recently, systematic criteria for type and screen, based on the procedure’s probability of transfusion were introduced by Dexter et al. We used this algorithm for retrospective analyses on our perioperative data in our Anesthesia Information Management System (AIMS) system and evaluated the effects on frequency and costs in the TS policy.
Methods: Data of 20132 patients who underwent a surgical procedure, recorded in our AIMS were compiled. Preoperative data were added to the data set. For each procedure the median estimated blood loss (mEBL), the minimal blood loss threshold and the incidence of blood transfusion were analyzed. These data were used to guide future decisions for type and screen. A confidence interval of >95% with a transfusion incidence of < 5.0% was taken as safety limit to avoid unnecessary type and screen.
Results: A mEBL of 400 ml showed a transfusion incidence of >5% with a confidence interval of >95%. A costs analysis estimated a potential cost reduction of at least 97.3 % or € 150.000 a year, when looking at TS unnecessary performed over the past 2 years.
Conclusions: We determined in this study the minimal EBL to be more than 400 ml to advocate TS in our population. The regime is easy to implement with the use of an AIMS system and will most likely lead to a reduction in costs.
