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Hamid M, Kershaw M, Bhakthavalsalan R, Shivamurthy R, Davies S, Singhal R, Nijjar R, Wiggins T, Camprodon R, Ahmed Z. Pre-Operative Group and Save in Elective and Emergency Laparoscopic Cholecystectomy: Necessity, Cost-Effectiveness, and Own Experience. J Clin Med 2024; 13:2749. [PMID: 38792291 PMCID: PMC11122548 DOI: 10.3390/jcm13102749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/07/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. Methods: A prospective multi-centre observational study was conducted to investigate patients undergoing either elective or emergency laparoscopic cholecystectomy in the UK between January 2020 and May 2021. Multivariate logistical regression models were used to identify patient factors associated with the risk of transfusion and explore outcomes linked to pre-operative G&S sampling. Results: This study comprised 959 patients, with 631 (65.8%) undergoing elective cholecystectomy and 328 (34.2%) undergoing emergency surgery. The median age was 48 years (range: 35-59), with 724 (75.5%) of the patients being female. Only five patients (0.5%) required blood transfusions, receiving an average of three units, with the first unit administered approximately six hours post-operatively. Among these cases, three patients (60%) had underlying haematological conditions. In adjusted models, male gender was significantly associated with the need for a blood transfusion (OR 11.31, p = 0.013), while the presence of a pre-operative Group and Save sample did not demonstrate any positive impact on patient outcomes. Conclusions: The incidence of blood transfusion following laparoscopic cholecystectomy is very low. Male gender and haematological conditions may present as independent risk factors. Pre-operative G&S sampling did not yield any positive impact on patient outcomes and could be safely excluded in both elective and emergency cases, although certain population subsets will warrant further consideration.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Marie Kershaw
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Resya Bhakthavalsalan
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishika Shivamurthy
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Sian Davies
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rishi Singhal
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Rajwinder Nijjar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Tom Wiggins
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Ricardo Camprodon
- Dudley Group NHS Foundation Trust, Russell’s Hall Hospital, Pensnett Rd., Dudley DY1 2HQ, UK
| | - Zuhair Ahmed
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2TH, UK
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Sueda A, Kagawa T, Kojima T. Quality improvement in paediatric preoperative screening: a Japanese perspective. Anaesth Rep 2023; 11:e12267. [PMID: 38144713 PMCID: PMC10739157 DOI: 10.1002/anr3.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Affiliation(s)
- A. Sueda
- Department of AnaesthesiologyHyogo Prefectural Kobe Children's HospitalKobeJapan
| | - T. Kagawa
- Department of AnaesthesiologyHyogo Prefectural Kobe Children's HospitalKobeJapan
| | - T. Kojima
- Department of AnaesthesiologyAichi Children's Health and Medical CenterAichiJapan
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Truong T, Mutavdzija M, Seglenieks R, Nathan H, Horton R. A health economic evaluation of the unnecessary ordering of coagulation studies and blood grouping prior to elective surgery. J Perioper Pract 2022:17504589221132402. [PMID: 36448077 DOI: 10.1177/17504589221132402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Unnecessary pathology tests add significant financial burden to health care expenditures while offering limited benefit to patients. Current guidelines do not support indiscriminate ordering of preoperative coagulation studies and ABO blood typing. We sought to estimate the incidence and financial cost of the indiscriminate ordering of these investigations in our institution. A single centre retrospective electronic chart review was performed in patients who underwent preoperative coagulation studies or ABO blood typing prior to elective surgery over a ten-month period. Using local evidence-based guidelines, only 9% of coagulation studies and 75% of ABO blood typing studies were indicated. The estimated cost of unnecessary tests in our cohort of 2688 patients was approximately AUD35,500. Interventions such as directed education and clinician feedback should be considered to combat the high incidence of indiscriminate ordering of preoperative coagulation studies and ABO blood typing.
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Affiliation(s)
- Tony Truong
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, VIC, Australia
| | - Michael Mutavdzija
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, VIC, Australia
| | - Richard Seglenieks
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, VIC, Australia
- Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Haran Nathan
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, VIC, Australia
| | - Richard Horton
- Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, VIC, Australia
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Fadel MG, Patel I, O'Leary L, Behar N, Brewer J. Requirement of preoperative blood typing for cholecystectomy and appendectomy: a systematic review. Langenbecks Arch Surg 2022; 407:2205-2216. [PMID: 35779099 PMCID: PMC9468044 DOI: 10.1007/s00423-022-02600-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose Blood typing, or group and save (G&S) testing, is commonly performed prior to cholecystectomy and appendectomy in many hospitals. In order to determine whether G&S testing is required prior to these procedures, we set out to evaluate the relevant literature and associated rates of perioperative blood transfusion. Methods Studies from January 1990 to June 2021 assessing the requirement of preoperative G&S testing for elective or emergency cholecystectomy and appendectomy were retrieved from MEDLINE, EMBASE and CINAHL databases. The search was performed on 6th July 2021 (PROSPERO registration number CRD42021267967). Number of patients, co-morbidities, operation performed, number of patients that underwent preoperative G&S testing, perioperative transfusion rates and financial costs were extracted. Results We initially screened 194 studies of which 15 retrospective studies, a total of 477,437 patients, specifically met the inclusion criteria. Ten studies reported on cholecystectomy, two studies on appendectomy and three studies included both procedures. Where reported, a total of 177,539/469,342 (37.8%) patients underwent preoperative G&S testing with a perioperative transfusion rate of 2.1% (range 0.0 to 2.1%). The main preoperative risk factors associated with perioperative blood transfusion identified include cardiovascular co-morbidity, coagulopathy, anaemia and haematological malignancy. All 15 studies concluded that routine G&S is not warranted. Conclusion The current evidence suggests that G&S is not necessarily required for all patients undergoing cholecystectomy or appendectomy. Having a targeted G&S approach would reduce delays in elective and emergency lists, reduce the burden on the blood transfusion service and have financial implications. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02600-x.
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Affiliation(s)
- Michael G Fadel
- Department of General Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
| | - Ishaan Patel
- Department of General Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Lawrence O'Leary
- Department of General Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Nebil Behar
- Department of General Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - James Brewer
- Department of General Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
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Long B, Long DA, Koyfman A. Emergency medicine misconceptions: Utility of routine coagulation panels in the emergency department setting. Am J Emerg Med 2020; 38:1226-1232. [PMID: 32029342 DOI: 10.1016/j.ajem.2020.01.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/17/2019] [Accepted: 01/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coagulation panels are ordered for a variety of conditions in the emergency department (ED). OBJECTIVE This narrative review evaluates specific conditions for which a coagulation panel is commonly ordered but has limited utility in medical decision-making. DISCUSSION Coagulation panels consist of partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT), prothrombin time (PT), and international normalized ratio (INR). These tests evaluate the coagulation pathway which leads to formation of a fibrin clot. The coagulation panel can monitor warfarin and heparin therapy, evaluate for vitamin K deficiency, evaluate for malnutrition or severe systemic disease, and assess hemostatic function in the setting of bleeding. The utility of coagulation testing in chest pain evaluation, routine perioperative assessment, prior to initiation of anticoagulation, and as screening for admitted patients is low, with little to no change in patient management based on results of these panels. Coagulation testing should be considered in systemically ill patients, those with a prior history of bleeding or family history of bleeding, patients on anticoagulation, or patients with active hemorrhage and signs of bleeding. Thromboelastography and rotational thromboelastometry offer more reliable measures of coagulation function. CONCLUSIONS Little utility for coagulation assessment is present for the evaluation of chest pain, routine perioperative assessment, initiation of anticoagulation, and screening for admitted patients. However, coagulation panel assessment should be considered in patients with hemorrhage, patients on anticoagulation, and personal history or family history of bleeding.
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Affiliation(s)
- Brit Long
- Brooke Army Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Drew A Long
- Brooke Army Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
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Yonekura H, Ide K, Kanazawa Y, Takeda C, Nakamori Y, Matsunari Y, Sakai M, Kawakami K, Kamei M. Use of preoperative haemostasis and ABO blood typing tests in children: a retrospective observational study using a nationwide claims database in Japan. BMJ Open 2019; 9:e032306. [PMID: 31780592 PMCID: PMC6886946 DOI: 10.1136/bmjopen-2019-032306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe the prevalence and factors associated with preoperative haemostasis and ABO blood typing tests for children because these tests might represent low-value care. DESIGN A retrospective observational study. SETTING Nationwide insurance claims database in Japan. PARTICIPANTS Patients aged 1-17 years who underwent common non-cardiac surgeries between April 2012 and March 2018 were included. Patients with high-risk comorbidities for bleeding (n=175) and those with multiple eligible surgeries were excluded (n=2121). MAIN OUTCOME MEASURES We described the proportions of each preoperative test performed within 60 days before an index surgery, including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and ABO blood typing tests. We also explored the associations between patient-level and institutional-level factors and any preoperative tests, using multilevel logistic regression analysis. RESULTS We included 13 018 patients (median (IQR) age, 5.2 (2.9-7.7) years; 8276 (63.6%) boys) from 1499 institutions. The overall proportion of each test was as follows: platelet count, 78.6%; PT, 54.4%; aPTT, 56.4% and ABO blood typing tests, 50.4%. The proportion of patients undergoing any preoperative tests in the overall sample was 79.3%. Multilevel logistic regression analysis indicated that preoperative tests were associated with type of anaesthesia (general anaesthesia: adjusted OR 7.06; 95% CI 4.94 to 10.11), type of surgery (tonsillectomy: adjusted OR 3.45; 95% CI 2.75 to 4.33) and surgical setting (inpatient procedure: adjusted OR 5.41; 95% CI 3.83 to 7.66). There was one postoperative transfusion event (0.008%) in the entire cohort and 37 postoperative reoperation events for surgical bleeding after tonsillectomy (0.90%). CONCLUSIONS In the largest Japanese cohort reported to date, preoperative haemostasis and ABO blood typing tests were performed in a majority of children prior to common paediatric surgeries. Preoperative tests were associated with anaesthesia, surgical type and surgical setting.
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Affiliation(s)
- Hiroshi Yonekura
- Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Kyoto, Japan
| | - Kazuki Ide
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Kyoto, Japan
| | - Yuji Kanazawa
- Department of Otolaryngology, Shiga Medical Centre for Children, Moriyama, Shiga, Japan
| | - Chikashi Takeda
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Kyoto, Japan
| | - Yuki Nakamori
- Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yasunori Matsunari
- Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Michihiro Sakai
- Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Kyoto, Japan
| | - Masataka Kamei
- Department of Clinical Anesthesiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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