Analysis of Blood Usage in Elective Surgical Procedures in a District General Hospital, Sri Lanka: Step towards Maximum Surgical Blood Ordering Schedule (MSBOS)

Abstract

Abstract— Objective is to evaluate the current practice of blood ordering and utilization in elective surgical procedures. It aims the formulation of MSBOS to streamline the blood usage and stock management. Retrospective study was conducted for six months period. All cross match requests related to all elective surgical procedures were analyzed for number of blood units requested and transfusions during first half of 2017. Cross match: transfusion (C: T) ratio, Transfusion index (TI) and Transfusion probability (%T) were calculated for each procedure. Total number of surgical procedures those requested blood transfusion were 35. 2348 cross matches have been done for 1707 patients. 9% of the total blood transfusions (n =2073) is for elective surgeries. Only 192 (8%) procedures have utilized cross matched blood and 92% were uncomplicated. Cross match: Transfusion (C: T) ratio is higher than the standard for all the surgeries except for open reduction internal fixation (ORIF) surgery (1.6:1). The procedures which have Transfusion Index (TI) > 0.5 is the total knee or hip replacement surgery (0.7) and ORIF . Only four surgeries have %T of > 30 %. Indices used to determine the efficiency of blood ordering and utilization are C: T ratio, TI and %T. C: T ratio <2.5 and / or TI of ≥0.5 indicates efficient blood usage. %T of ≥30% indicates significant blood usage. According to this study most of surgeries could be managed by Group and Save method without cross matching blood for each procedure. The requirement of a MSBOS was obvious. MSBOS is a guide to optimize blood usage without compromising standard patient care.