Intro Preoperative type and screen (T&S) is traditionally ordered for patients undergoing laparoscopic hysterectomy. We aimed to evaluate if it is cost-effective and clinically warranted in this population.
Methods A retrospective case-control study was conducted of all patients who underwent laparoscopic hysterectomy at a tertiary care center and its associated referral hospital between 01/01/2001 and 09/01/2019. Cases were defined as patients who received a perioperative red blood cell transfusion (72 hours before or after surgery). Differences between groups were analyzed using an independent samples t-test for means, Wilcoxon rank sum test for medians, and chi-square for categorical variables.
Results Among 8,321 patients who underwent laparoscopic hysterectomy, 61 (0.73%) had a perioperative transfusion. Age and smoking status were similar between groups; however, cases were more likely to be African-American, Asian and have a body mass index greater than 30 (p<0.05). Of those transfused, 23 (37.1%) were intraoperatively (seven for preoperative anemia, 13 for large blood loss, two for vascular injury and one for unknown reasons). Conversion to laparotomy occurred in 27 cases, of which five underwent transfusion. Only four transfusions (0.05% of hysterectomies) were performed urgently where un-crossmatched O-negative blood would have been required. Eliminating T&S in this population would have saved $624,075 to $832,100 during the study period.
Conclusion/Implications Routine T&S is not cost-effective nor clinically useful for the majority of patients undergoing laparoscopic hysterectomy. Further analysis might identify a subset of patients who are at higher risk of blood loss and would benefit from a T&S.
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