Context: Preoperative blood bank testing should optimize the trade-off between intraoperative
transfusion delay and blood wastage. Aims: This study aims to develop a maximal surgical blood order schedule (MSBOS) for elective
neurosurgery. Settings and Design: Prospective data in University Teaching Hospital, Northern Thailand. Subjects and Methods: Blood transfusion data were collected on all adult patients satisfying inclusion/exclusion
criteria in 2015. Patients were assigned to ten procedure groups (G): vascular: (1)
Aneurysm/arteriovenous malformation, (2) Cerebrovascular bypass; tumor resection:
(3) Meningioma, (4) Other, (5) Cerebellopontine angle, (6) Pituitary/craniopharyngioma,
(7) Endoscopic pituitary; and miscellaneous: (8) Cranioplasty, (9) Spine, (10) Other.
The crossmatch-transfusion ratio (C/T), transfusion probability (%T), and transfusion
index (Ti) were calculated. MSBOS was generated by applying published criteria, subjected
to clinical neurosurgical judgment. Statistical Analysis Used: Statistical Package
for the Social Sciences, Vision 20. Results: Of 377 patients, 95% underwent preoperative cross-and-match (C and M) testing for
1422 red blood cell (RBC) units, while 3% had no type and screen (T and S) nor C and
M, and 2% had T and S only. Overall C/T was 6.6, with range from 4 for G3-53 for G8.
Intraoperative %T was 27%. Intraoperative Ti was 0.6. Our MSBOS recommended T and
S only for G2, G7, G8, G9, G10; C and M of 2 RBC units for G1, G4, G5, G6; and C and
M 2-to-4 for G3. If this were followed in 2015, intraoperative blood needs would have
been satisfied for ≥82% of patients, and substantial reductions achieved in blood
banking fees. Conclusions: Our MSBOS may help optimize blood ordering and serve as an example for similar efforts
for other surgical specialties.
Key-words:
Blood transfusion - crossmatch-transfusion ratio - elective neurosurgery - maximal
surgical blood order schedule - transfusion index - transfusion probability
