Efficacy of Blood Utilization in Elective Surgery for Non-COVID Patients during COVID-19 Outbreaks
Abstract
Objective: This study aimed to evaluate the pattern of blood transfusion requests and utilization in non-coronavirus disease (COVID) patients having undergone elective surgeries during the COVID-19 pandemic.
Material and Methods: The pattern of blood transfusion requests and utilization for elective surgical procedures in six departments of a University Hospital; between January 2020 and December 2021, were retrospectively evaluated. The cross-match-to transfusion (C/T) ratio, transfusion probability (%T), transfusion index (Ti), and maximum surgical blood order schedule (MSBOS) were calculated.
Results: A total of 15,030 patients underwent elective surgery. Among the 14,426 units of blood requested, 12,776 (89%) units were cross-matched preoperatively for 5,799 (39%) patients, and an additional 1,650 (11%) units were requested for 394 (2.6%) patients intraoperatively. Among these, 4,588 (32%) units were transfused to 1,710 (11.4%) patients. The overall C/T ratio, %T, and Ti were 2.78, 29.5%, and 0.79, respectively. Blood utilization indices for each department varied substantially according to the type of surgery, with blood utilization indices being unfavorable for 68 (80%) of the 85 procedures. The MSBOS was 0 for 32 procedures.
Conclusion: Over-ordering of blood units for elective surgical procedures remained common during the COVID-19 pandemic. The blood utilization indices showed substantial variations according to the type of surgical procedures. The MSBOS has been formulated to assist in future decision-making.
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Carson JL, Guyatt G, Heddle NM, Grossman BJ, Cohn CS, Fung MK, et al. Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage. JAMA 2016;316:2025-35. doi: 10.1001/jama.2016.9185.
Hasan O, Khan EK, Ali M, Sheikh S, Fatima A, Rashid HU. “It’s a precious gift, not to waste”: is routine cross matching necessary in orthopedics surgery? Retrospective study of 699 patients in 9 different procedures. BMC Health Serv Res 2018;18:804.
Saringcarinkul A, Chuasuwan S. Maximum surgical blood order schedule for elective neurosurgery in a university teaching hospital in northern Thailand. Asian J Neurosurg 2018;13:329–35.
Tan PP, Abdul RJ, Mat NS, Mohd YI, Mohd NS. Implementation of maximum surgical blood ordering schedule in a tertiary hospital in Malaysia during COVID-19 pandemic. Transfus Apher Sci 2021;60:103280. doi: 10.1016/j.transci.2021.103280.
Woodrum CL, Wisniewski M, Triulzi DJ, Waters JH, Alarcon LH, Yazer MH. The effects of a data driven maximum surgical blood ordering schedule on preoperative blood ordering practices. Hematology 2017;22:571-7.
Kim J, Kim H, Shin K, Kim HH, Lee H. Necessity for regular updates of the maximum surgical blood order schedule (MSBOS). Korean J Blood Transfus 2022;33:97-106.
Mahattanobon S, Sunpaweravong S. Blood order guideline for elective surgery: Impact of a guideline. Songkla Med J 2008;26:491-500.
Wanasuwannakul T, Vasinanukorn M, Lim A. Appropriate blood order for elective surgical procedures in Songklanagarind Hospital: analyzed from the types of operation, patients, baseline hematocrit and underlying diseases. Thai J Anesthesiol 2005;31:271-80.
Lertpaisankul, S Phomsila R, Thipsuwankul W, Phetsree N, Rodwihok T, Tadsomboon S. Model of blood recruitment and impact of blood management of the six lower-northern provinces during the COVID-19 pandemic in 2020. J Hematol Transfus Med 2021;31:35-45.
Kandasamy D, Shastry S, Chenna D, Mohan G. COVID-19 pandemic and blood transfusion services: the impact, response and preparedness experience of a tertiary care blood center in southern Karnataka, India. Hematol Transfus Cell Ther 2022; 44:17-25.
Zewdie K, Genetu A, Mekonnen Y, Worku T, Sahlu A, Gulilalt D. Efficiency of blood utilization in elective surgical patients. BMC Health Serv Res 2019;19:804.
Belayneh T, Messele G, Abdissa Z, Tegene B. Blood requisition and utilization practice in surgical patients at university of Gondar Hospital, northwest Ethiopia. J Blood Transfus 2013;2013:758910. doi: 10.1155/2013/758910.
Shaikh OH, Bhattarai S, Shankar VG, Basavarajegowda A. Blood ordering and utilization in patients undergoing elective general surgery procedures in a tertiary care hospital: a prospective audit. Natl Med J India 2022;35:68-73.
Barth M, Weiss C, Schmieder K. Red blood cell transfusion probability and associated costs in neurosurgical procedures. Acta Neurochir 2018;160:1483-9. doi: 1007/s00701-018-3516-x.
Raghuwanshi B, Pehlajani NK, Sinha MK, Tripathy S. A retrospective study of transfusion practices in a tertiary care institute. Indian J Anaesth 2017;61:24-8.
Mangwana S, Bedi N, Yadav P, Chugh R. Optimization of blood transfusion services: analysis of blood requisition and utilization practices in cardiac surgical patients in a tertiary care hospital, India. Glob J Transfus Med AATM 2017;2:47-51.
Chotisukarat H, Akavipat P, Sookplung P, Damrongbul K. Effectiveness index of preoperative blood preparation for elective neurosurgery at Prasat Neurological Institute. Thai J Anesthesiol 2017;43:232–40.
Tunthanathip T, Sae-Heng S, Oearsakul T, Kaewborisutsakul A, Taweesomboonyat C. Economic impact of a machine learningbased strategy for preparation of blood products in brain tumor surgery. PLOS ONE 2022;17:0270916. doi: 10.1371/journal.pone.0270916.
Nuttall GA, Santrach PJ, Oliver WC Jr, Ereth MH, Horlocker TT, Cabanela ME, et al. A prospective randomized trial of the surgical blood order equation for ordering red cells for total hip arthroplasty patients. Transfusion 1998;38:828-33.
Kajja I, Bimenya GS, Eindhoven GB, Duis HJ, Sibinga CT. Surgical blood order equation in femoral fracture surgery. Transfus Med 2011;21:7-12.
Palmer T, Wahr JA, O’Reilly M, Greenfield ML. Reducing unnecessary cross-matching: a patient-specific blood ordering system is more accurate in predicting who will receive a blood transfusion than the maximum blood ordering system. Anesth Analg 2003;96:369-75.
Misganaw A, Simegn GD, Bayable SD, Aschale A, Beyable AA, Ashebir YG, et al. The practice of blood cross-match request and transfusion in surgical patients at Debre Markos comprehensive Specialized Hospital, Debre Markos, Ethiopia 2021/2022: a prospective study. Ann Med Surg 2022;80:104145. doi: 10.1016/j.amsu.2022.104145.
Guzman JPS, Resurreccion LL, Gepte MBP. Use of maximum surgical order schedule (MSBOS) among pediatric patients to optimize blood utilization. Ann Pediatr Surg 2019;15:4.
Loong TY. Guidelines on blood and blood components transfusion: maximum surgical blood order schedule (MSBOS) for elective surgery [monograph on the Internet]. Cheras, Kuala Lumpur: UKM Medical Center; 2019 [cited 2023 Oct 8]. Available from: https://hctm.ukm.my/makmal/wp-content/uploads/2020/10/2-MSBOS-ed.5.pdf
Friedman BA, Oberman HA, Chadwick AR, Kingdon KI. The maximum surgical blood order schedule and surgical blood use in the United States. Transfusion 1976;16:380‑7.
Friedman BA. An analysis of surgical blood use in United States hospitals with application to the maximum surgical blood order schedule. Transfusion 1979;19:268‑78.
Hall TC, Pattenden C, Hollobone C, Pollard C, Dennison AR. Blood transfusion policies in elective general surgery: how to optimise cross-match-to-transfusion ratios. Transfus Med Hemother 2013;40:27-31.
Stanworth SJ, New HV, Apelseth TO, Brunskill S, Cardigan R, Doree C, et al. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Haematol 2020;7:756–64.
Mead JH, Anthony CD, Sattler M. Hemotherapy in elective surgery: an incidence report, review of the literature, and alternatives for guideline appraisal. Am J Clin Pathol 1980;74:223-7.
Kerr RS. Surgery in the 2020s: implications of advancing technology for patients and the workforce. Future Healthc J 2020;7:46-9.
Miskeen E, Omer Yahia AI, Eljack TB, Karar HK. The impact of COVID-19 pandemic on blood transfusion services: a perspective from health professionals and donors. J Multidiscip Healthc 2021;14:3063-71.
Yasmeen I, Ahmed I, Bashir S. Efficiency of blood utilization and characteristics of patients receiving blood transfusion at an associated hospital in North India. Int J Res Med Sci 2021;9:1056-59.
Sripara P, Boonmawongsa N, Benjangkaprasert B. Impact of COVID-19 pandemic on blood donation in blood transfusion center, Faculty of Medicine, Khon Kaen University. Srinagarind Med J 2023;38:104-111.
Kaur P, Bedi RK, Mittal K, Sood T. Exploring the unseen effect of COVID 19 pandemic on blood transfusion services in a tertiary care centre. Transfus Apher Sci 2023;62:103569. doi: 10.1016/j.transci.2022.103569.
Moghaddamahmadi M, Khoshrang H, Khatami SS, Hooshmand MA, Ghovvati CH, Mehrkhah S. Survey of maximum blood ordering for surgery (MSBOS) in elective general surgery, neurosurgery and orthopedic surgery at the Poursina Hospital in Rasht, Iran, 2017. Hematol Transfus Cell Ther 2021;43:482-8.
Jo C, Ko S, Shin WC, Han HS, Lee MC, Ko T, et al. Transfusion after total knee arthroplasty can be predicted using the machine learning algorithm. Knee Surg Sports Traumatol Arthrosc 2020;28:1757-64.
Chen Y, Cai X, Cao Z, Lin J, Huang W, Zhuang Y, et al. Prediction of red blood cell transfusion after orthopedic surgery using an interpretable machine learning framework. Front Surg 2023;10:1047558. doi:10.3389/fsurg.2023.1047558.
Wang Z, Zhe S, Zimmerman J, Morrisey C, Tonna JE, Sharma V, et al. Development and validation of a machine learning method to predict intraoperative red blood cell transfusions in cardiothoracic surgery. Sci Rep 2022;12:1355. doi: 10.1038/s41598-022-05445-y.
Lou SS, Liu H, Lu C, Wildes TS, Hall BL, Kannampallil T. Personalized surgical transfusion risk prediction using machine learning to guide preoperative type and screen orders. Anesthesiology 2022;137:55-66.
Rubin R. It takes an average of 17 years for evidence to change practice-the burgeoning field of implementation science seeks to speed things up. JAMA 2023;329:1333-6.
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