Routine preoperative group and save for TURP and TURBT – need and cost effectiveness

Abstract

Introduction: Standard practice in our unit is to take a group and save (G+S) blood sample for all patients undergoing a transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT). Modern studies show the transfusion rates for TURP are 2%–7% and for TURBT 2%. Aims: We will determine how many patients undergoing TURP and TURBT required blood transfusion, analyse the indication, timing and risk factors. Additionally we will assess the cost effectiveness of routine G+S. Methods: A retrospective analysis was conducted between 1 March 2015 and 29 February 2016 (one year). Patients were identified from OPERA database and cross-referenced with blood transfusion records. Electronic case notes for patients receiving transfusions were reviewed. Results: A total of 167 patients underwent TURP. Of these, 0.6% (1/167) received transfusion on day 4 post-op. A total of 160 patients underwent TURBT. Overall 3.8% (6/160) received transfusion: three patients on days 0–1 and three patients on days 2–30. All patients had pre-op Hb <100 g/l. All had large muscle-invasive tumours. Cost in our lab of a G+S sample is £23.52. Two samples are now required before blood can be issued. Discussion: Our study shows that risk factors for transfusion are large prostates, likely muscle-invasive bladder tumours and pre-op Hb <100 g/l. Other risks include coagulopathy. These will usually be identified by the surgeon or pre-assessment clinic prior to the procedure. Change in policy would save money and time of phlebotomists and junior doctors. Conclusions: Routine G+S is not necessary for all patients. Patients with risk factors can be identified preoperatively. This would give a potential saving of over £15,000 per year. This can be implemented without adversely affecting patient safety.