Cost analysis of blood group and antibody screening for emergency appendicectomy: Should we stop?

Abstract

Introduction: The rate of transfusion associated with emergency laparoscopic general surgery has been shown to be 0.36%. A significant number of patients undergo group and antibody screening due to perceived risk of hemorrhage. All NHS hospitals have massive transfusion policies with immediate availability of O-negative blood. Blood group and antibody screening carries a cost of £35. The aim of this study was to determine the cost-effectiveness of group and antibody screening vs crossmatching where required. Materials and methods: All patients undergoing emergency appendicectomy over a 3-year period were retrospectively identified. The transfusion service then identified whether blood had been issued. Results: A total of 645 emergency appendicectomies were identified: 603 were laparoscopic and 42 open. One (0.2%) patient received a transfusion of 2 units. Discussion: Our study has shown a rate of transfusion of 0.2%. If patients were crossmatched as required rather than group and screening, this would give a cost saving of £35 per patient or £22345 across our trust. There are 50,000 appendicectomies per year in the United Kingdom. If this saving were extrapolated, it would generate a saving of £1.1M. Conclusion: Our recommendation would be to crossmatch where required. The cost saving to the NHS could be up to £1.1M with little impact on the demand for O-negative blood.