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Selective type & screen for elective colectomy based on a transfusion risk score may generate substantial cost savings

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Abstract

Background

Preoperative type and screen are currently recommended for all patients undergoing colectomy. We aimed to identify risk factors for transfusion and define a low-risk cohort of patients undergoing colectomy in whom type and screen may be safely avoided.

Methods

We identified all patients undergoing elective colectomy in the National Surgical Quality Improvement Project-Targeted Colectomy files from 2012 to 2016. Patients transfused preoperatively and those undergoing other concurrent major abdominal procedures were excluded. We compared patients who received blood transfusion on the day of surgery to those who did not. Half of the cohort was randomly selected for development of a points-based model predicting blood transfusion on the day of surgery. This model was then validated using the remaining patients.

Results

Of 61,964 patients undergoing colectomy, 3128 (5%) patients were transfused with 1290 (2.1%) occurring on the day of surgery. Preoperative anemia was the strongest predictor of blood transfusion on the day of surgery. Among patients with hematocrit > 35%, day of surgery transfusion risk was 0.8%; 99% of patients with hematocrit > 35% had a score 20 or less. Selective type and screen for patients with score ≤ 20 or hematocrit > 35% would avoid type and screen in 91% and 81% of patients, respectively.

Conclusion

Transfusion following elective colectomy is rare and can be accurately predicted by preoperative patient characteristics. Selective type and screen based on these parameters have the potential to prevent operative delays and lower cost.

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Funding

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Authors and Affiliations

  1. Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, Suite 249, MSC 295, Charleston, SC, 29425, USA

    Alexander T. Booth, Shelby Allen, Virgilio V. George & Thomas Curran

  2. Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    Vlad V. Simianu

  3. Department of Surgery, University of Minnesota, Minneapolis, MN, USA

    Christine C. Jensen

  4. Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Marc L. Schermerhorn

Authors
  1. Alexander T. Booth
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  2. Shelby Allen
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  3. Vlad V. Simianu
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  4. Christine C. Jensen
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  5. Marc L. Schermerhorn
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  6. Virgilio V. George
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  7. Thomas Curran
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Contributions

Protocol/project development: TC, VVS, CCJ, MLS, and VVG. Data collection or management: TC. Data analysis: all authors. Manuscript writing/editing: all authors. Final approval/accountability agreement: all authors.

Corresponding author

Correspondence to Thomas Curran.

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Disclosures

Alexander T. Booth, Shelby Allen, Vlad V. Simianu, Christine C. Jensen, Marc L. Schermerhorn, Virgilio V. George, and Thomas Curran declare that they have no conflict of interest.

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Presentations: This work was presented at as a QuickShot Podium Presentation at Digestive Disease Week, May 2019.

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Booth, A.T., Allen, S., Simianu, V.V. et al. Selective type & screen for elective colectomy based on a transfusion risk score may generate substantial cost savings. Surg Endosc 36, 8817–8824 (2022). https://doi.org/10.1007/s00464-022-09307-6

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  • DOI: https://doi.org/10.1007/s00464-022-09307-6

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