Page 29 - World Journal of Laparoscopic Surgery

RESEARCH ARTICLE
Cost Analysis of Blood Group and Antibody Screening for

Emergency Appendicectomy: Should We Stop?

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Ian S Farrell , James Hall , James Hill 3
AbstrAct
Introduction: 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.
Keywords: Appendicectomy, Laparoscopy, Transfusion.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1414

IntroductIon 1–3 Department of General Surgery, Manchester Royal Infirmary,

The rate of blood transfusion associated with any form of Manchester, England, UK
laparoscopic general surgery is low. A recent single-center study Corresponding Author: Ian S Farrell, Department of General Surgery,
looking at elective laparoscopic day case surgery revealed no Manchester Royal Infirmary, Manchester, England, UK, e-mail: ian.
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transfusions in a 2-year period in 532-day case patients. Similarly, farrell@doctors.org.uk
a study investigating transfusions during emergency laparoscopic How to cite this article: Farrell IS, Hall J, Hill J. Cost Analysis of Blood
appendicectomy, cholecystectomy, and diagnostic laparoscopy Group and Antibody Screening for Emergency Appendicectomy:
found the rate of transfusion to be less than 0.4% in the peri- Should We Stop? World J Lap Surg 2020;13(3):128–129.
operative or immediate postoperative period (Day 1 postoperative) Source of support: Nil

in 562 patients. 2 Conflict of interest: None
There is a perception that there is an increased risk of major
hemorrhage during laparoscopic surgery from anesthetic and
surgical staff, despite the evidence that transfusion rates are low. of hemolytic transfusion reactions in only 1 in 70,000 O-negative
In addition to this, there is no national guidance on preoperative transusions. 5
blood screening for emergency laparoscopic surgery. In our trust, Routine blood group and antibody screening prior to surgery
it remains policy that patients undergoing emergency laparoscopic has an associated cost of approximately £17.50 per sample in our
procedures have group and screen tests carried out prior to theater. unit. The requirement for two samples prior to transfusion brings
The purpose of group and screen is to screen for unusual the cost of screening to £35 per patient.
antibodies and also to allow transfusion laboratories to store The aim of this study was to determine the cost-effectiveness
samples to crossmatch if blood is required. This test takes of blood group and antibody screening for appendicectomy
approximately 45 minutes. Blood crossmatch takes approximately compared to crossmatching as required together with the use
60 minutes before blood is available, this shows that there is no of O-negative blood when massive peri-operative transfusion is
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presence of unusual blood antibodies. For major hemorrhage required.
scenarios, all NHS hospitals are required to have a massive
transfusion policy with immediate O-negative blood availability MAterIAls And Methods
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in major hemorrhage scenarios. Conventional wisdom dictates
that all perioperative transfusions should be type specific in order All patients undergoing appendicectomy in our center over a 3-year
to minimize risk of transfusion reactions; however, transfusion of period were retrospectively identified. All patients under 16 and
O-negative blood only carries a very low additional risk of non- all nonemergency cases were excluded. The patient records were
ABO-alloantibody incompatibility. Studies have shown an incidence examined to determine whether preoperative group and antibody

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