PDF(Pubmed)
Abstract：
Background Pre-surgical group and save (G&S) tests are routine but can result in unnecessary expense and theatre delays. The objective of this study was to assess the necessity of G&S testing prior to appendectomy and evaluate the cost implications. Methods This retrospective study analysed the records of 200 patients with appendicitis who underwent emergency appendectomies at a busy general surgery department between March 2021 to August 2022. The study adhered to local clinical governance unit protocol and the Strengthening the Reporting of Cohort Studies in Surgery (STROCCS) guidelines. Patients who had elective appendectomies or other emergency procedures were excluded. Data was collected on age, gender, number of samples and requirement for perioperative transfusion. Comparisons were drawn between patients who underwent laparoscopic, open or converted emergency appendectomies. Results Of the sample population, (median age 32, 55.5% male), 93.5% had valid preoperative G&S tests. None required perioperative blood transfusions. 26% of the patients only required one sample for a valid G&S due to having previous sample in the lab; 55% required two samples; 7% needed a third sample because one initial sample was rejected; and 5.5% required four samples because the initial two samples were rejected. The total cost of these samples was estimated to be £3,500.14. Conclusion Emergency appendectomy poses minimal risk of resulting in the need for blood transfusions. Reevaluating the need for routine preoperative G&S testing and adopting a risk-benefit analysis approach could have a financial benefit for the NHS.
摘要：
背景技术手术前分组和保存(G&S)测试是常规的,但是可能导致不必要的费用和手术室延迟。本研究的目的是评估阑尾切除术前G&S检测的必要性，并评估成本影响。方法这项回顾性研究分析了2021年3月至2022年8月在繁忙的普外科接受急诊阑尾切除术的200例阑尾炎患者的记录。该研究遵循了当地临床治理单元协议和加强外科队列研究报告（STROCCS）指南。接受选择性阑尾切除术或其他急诊手术的患者被排除在外。数据是根据年龄收集的，性别,围手术期输血的样本数量和需求。在接受腹腔镜检查的患者之间进行了比较，打开或转换紧急阑尾切除术。样本人群的结果，（平均年龄32岁，男性占55.5%），93.5%术前G&S检测有效。没有人需要围手术期输血。26%的患者只需要一个样本来获得有效的G&S，因为之前在实验室有样本；55%需要两个样本；7%需要第三个样本，因为一个初始样本被拒绝；5.5%需要四个样本，因为最初的两个样本被拒绝。这些样品的总成本估计为3,500.14英镑。结论急诊阑尾切除术导致输血需求的风险最小。重新评估常规术前G＆S测试的需求并采用风险收益分析方法可能会为NHS带来经济利益。
