Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;36(12):8817-8824.
doi: 10.1007/s00464-022-09307-6. Epub 2022 May 26.

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

Affiliations

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

Alexander T Booth et al. Surg Endosc. 2022 Dec.

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.

Keywords: Anemia; Blood transfusion; Colectomy.

PubMed Disclaimer

References

    1. Elwood NR et al (2018) The negative effect of perioperative red blood cell transfusion on morbidity and mortality after major abdominal operations. Am J Surg 216(3):487–491 - DOI - PubMed - PMC
    1. Amri R et al (2017) Do packed red blood cell transfusions really worsen oncologic outcomes in colon cancer? Surgery (United States) 162(3):586–591
    1. Aquina CT et al (2016) Large variation in blood transfusion use after colorectal resection: a call to action. Dis Colon Rectum 59(5):411–418 - DOI - PubMed
    1. Halabi WJ et al (2013) Blood transfusions in colorectal cancer surgery: Incidence, outcomes, and predictive factors: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg 206(6):1024–1033 - DOI - PubMed
    1. Stangenberg L et al (2016) Development of a risk prediction model for transfusion in carotid endarterectomy and demonstration of cost-saving potential by avoidance of “type and screen.” J Vasc Surg 64(6):1711–1718 - DOI - PubMed - PMC

LinkOut - more resources