title: Do we really need to routinely crossmatch blood before primary total knee or hip arthroplasty?
abstract: BACKGROUND
  A maximum surgical blood ordering schedule may lead to wastage of valuable resources due to over-ordering of blood and/or under-utilisation. We audited the results of a group-and-save (GS) policy for primary hip (THR) and knee (TKR) arthroplasty to evaluate its safety and practicality.
  
  
  METHODS
  We conducted a retrospective review of consecutive patients attending for THR (177) or TKR (137) over a period of 8 months (phase 1). Following introduction of a limited GS policy, 205 THR and 147 TKR were reviewed prospectively over a corresponding period of 8 months (phase 2). Corresponding THR and TKR groups in each phase were comparable with respect to age, gender, length of stay, operating surgeon, pre- and lowest postoperative hemoglobin, reason for and timing of transfusion. Quantities (units) of blood requested pre- and postoperatively, transfused and returned to the blood bank, were recorded.
  
  
  RESULTS
  77 and 62% of all blood requested for THR and TKR, respectively, in phase 1 was not used. 58 and 21% of patients undergoing THR and TKR, respectively, in phase 2 underwent preoperative GS, with 92% and 100% of all blood requested being used for transfusion. Overall, the quantity of blood returned was reduced by 25% for the THR group. Transfusion rates fell by 9% and 5% for the TKR and THR groups, respectively. We found no adverse events associated with blood from a GS sample. Cost savings of 37 800 euro were calculated estimated for the study period (phase 2).
  
  
  CONCLUSIONS
  For routine primary THR/TKR, GS policy is a safe procedure. Reduction in non-utilisation of blood has economic and cost-saving implications for limited healthcare resources. Having subsequently introduced a group-and-save policy for all patients undergoing routine THR/TKR, considerable savings have been identified after only 2 months.
authors.affiliation: Department of Orthopaedics, University Hospitals of Leicester NHS Trust, Glenfield Hospital, UK. GMMundy@aol.com
authors.forename: Gary M
authors.initials: GM
authors.lastname: Mundy
authors.forename: Kate
authors.initials: K
authors.lastname: Hardiment
authors.forename: John
authors.initials: J
authors.lastname: Revill
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Birtwistle
authors.forename: Richard A
authors.initials: RA
authors.lastname: Power
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001788:Blood Grouping and Crossmatching / Q000191:economics; D001803:Blood Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D011446:Prospective Studies; D012189:Retrospective Studies