Can we reduce routine blood ordering in spinal surgery

Abstract

SUMMARY Spinal reconstruction can be associated with major blood loss; because of the non existence of ordering guidelines, blood products are ordered preoperatively in excessive quantities. The aim of our study was to investigate the efficiency of our ordering routine. The records of 205 spinal surgery patients, over a period of 3 years were reviewed. The crossmatched to transfused (C-T) ratio was calculated for each pathology group and the safe number of units transfused was determined. A total of 929 units were crossmatched, whereas 84 patients required transfusion. In all, 404 units were not used (C-T ratio = 1.8). The greatest number of unused but cross matched units was observed in painful back surgery (C-T ratio = 3.9, P < 0.01 vs. other pathologies). For all the other pathology groups (scoliosis, tumor and fracture) fewer units can be ordered, except in neuromuscular scoliosis group (6 units used on average for each case). For spinal fusion, artificial disc replacement or simple discectomy, a group and save routine is adequate. In conclusion, less blood can be ordered for spinal surgery, except for cases of neuromuscular scoliosis. The blood units crossmatched for painful back surgery, were more than actually needed. With technological advancement historical blood crossmatching policies may need re-evaluation.