Preoperative cross-matching in major head and neck surgery: a study of a department's current practice and eligibility for electronic cross-matching

A Prospective Single Centre Study of Preoperative Blood Ordering Versus Actual Usage Among Patients Undergoing Elective Curative Oncological Resections in a Tertiary Care Hospital in India

This study was a prospective, observational study aimed to look at the preoperative ordering schedule, pattern of usage of blood products for elective oncological surgeries in order to develop an institutional maximal surgical blood ordering schedule (MSBOS) in a tertiary university setting teaching Hospital. All biopsy proven, consenting, cancer patients of age 18 to 80 years who underwent elective curative cancer surgery over a period of 1 year were included. Various details such as nature of procedure, preoperative haemoglobin, intraoperative blood loss, duration of surgery, and number of units cross-matched and used were recorded and analysed. For each procedure, cross-match to transfusion (CT) ratio, transfusion index (TI), and transfusion probability (T%) were calculated using standard formulas. In all, 740 patients underwent elective curative cancer surgery in 1 year, majority being women and head and neck cancer being most common site. Overall, 312 patients received blood or component transfusion in the intraoperative and/or postoperative (within 48 h) period constituting 42% of all patients, although 70% of patients had preserved packed cells and 55% had preserved fresh frozen plasma (FFP). Cross-matching of blood was adequate only in cases of liver surgeries, maxillectomy, staging laparotomy for ovarian carcinoma, and urological malignancies with a desirable CT ratio falling within 2.5. An institution specific-MSBOS was developed. The study found a significant over-ordering of blood products. By implementing MSBOS, one can plan the collection and stocking of blood products thereby saving money, labour, and time.

Benefits of VISION Max automated cross-matching in comparison with manual cross-matching: A multidimensional analysis

BACKGROUND

VISION Max (Ortho-Clinical Diagnostics, Raritan, NJ, USA) is a newly introduced automated blood bank system. Cross-matching (XM) is an important test confirming safety by simulating reaction between packed Red Blood Cells (RBCs) and patient blood in vitro before transfusion. We assessed the benefits of VISION Max automated XM (A-XM) in comparison with those of manual XM (M-XM) by using multidimensional analysis (cost-effectiveness and quality improvement).

MATERIALS AND METHODS

In a total of 327 tests (130 patients), results from A-XM and M-XM were compared. We assessed the concordance rate, risk priority number (RPN), turnaround time, hands-on time, and the costs of both methods. We further simulated their annual effects based on 37,937 XM tests in 2018.

RESULTS

The concordance rate between A-XM and M-XM was 97.9% (320/327, kappa = 0.83), and the seven discordant results were incompatible for transfusion in A-XM, while compatible for transfusion in M-XM. None of the results was incompatible for transfusion in A-XM, while compatible for transfusion in M-XM, meaning A-XM detect agglutination more sensitively and consequently provides a more safe result than M-XM. A-XM was estimated to have a 6.3-fold lower risk (229 vs. 1,435 RPN), shorter turnaround time (19.1 vs. 23.3 min, P < 0.0001), shorter hands-on time (1.1 vs. 5.3 min, P < 0.0001), and lower costs per single test than M-XM (1.44 vs. 2.70 USD). A-XM permitted annual savings of 46 million RPN, 15.1 months of daytime workers' labor, and 47,042 USD compared with M-XM.

CONCLUSION

This is the first attempt to implement A-XM using VISION Max. VISION Max A-XM appears to be a safe, practical, and reliable alternative for pre-transfusion workflow with the potential to improve quality and cost-effectiveness in the blood bank.

Predictive factors for perioperative blood transfusion in neck dissection

OBJECTIVES/HYPOTHESIS

There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND).

STUDY DESIGN

Retrospective cohort study.

METHODS

Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction.

RESULTS

Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery.

CONCLUSION

Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation.

LEVEL OF EVIDENCE

4.