RELEVANCE

The widespread adoption of minimally invasive surgical techniques reduces blood loss during surgical procedures. However, conducting mandatory primary blood typing and confirmatory immunohaematological testing (T&S: blood type ABO/Rh and anti-erythrocyte antibody screening) in all patients prior to surgery violates four of the seven quality criteria for medical care as defined by the World Health Organization.

OBJECTIVE

To determine the feasibility of implementing T&S testing and indications for testing prior to minimally invasive procedures.

MATERIAL AND METHODS

A retrospective analysis of all cases of hospitalization in a third-level institution in 2022—2023 was carried out. Demographic data of patients, information on surgical interventions, and risk factors for blood transfusions were analyzed. The proportion of surgical procedures with and without transfusions was also compared. Based on this information, a T&S assignment management strategy has been developed.

RESULTS

The total level of transfusions of blood components is 8%, while surgical patients account for 6%. The risk of transfusion of blood components increases 4-fold when transferred from another medical institution compared with planned hospitalization (odds ratio (OR) 3.65; 95% confidence interval (CI) 2.99—4.46; p<0.05), compared with emergency hospitalization (OR 1.27; 95% CI 1.17—1.38; p<0.05). The number of blood transfusions depends on the age and gender of the patient (p<0.05). The need for transfusion of donor red blood cells increases as hemoglobin levels decrease before surgery. The level of 122 g/l (Sp 72%, Se 67%) is associated with an increased risk (ROC AUC_Hb=0.76; 95% CI 0.74—0.77; p<0.0001) with a diagnostic accuracy of 87.3%. Thanks to the developed prescription algorithm, the number of T&S procedures decreased by 35% (from 38.000 to 24.000) per 10.000 surgeries, mainly due to reduced screening for anti-erythrocyte antibodies. Thus, the cost of conducting T&S for 10.000 surgeries were halved — from 16 million rubles to 8 million rubles.

CONCLUSIONS

Only a small proportion of surgical patients require blood transfusions. By eliminating certain clinical indications for T&S tests from routine practice, annual healthcare costs can be significantly reduced.