The health economics of blood use in cerebrovascular aneurysm surgery: the experience of a UK centre.
OBJECTIVE
Surgical treatment of patients presenting with subarachnoid haemorrhage secondary to a leaking cerebrovascular aneurysm involves coiling or clipping. Traditionally all patients undergoing this procedure are cross-matched routinely. With ever-increasing strains on the health budget and transfusion services in particular, as well as the real, albeit low risk of transfusion transmitted disease, we propose that a simple 'group and save', coupled with a reliable 'fast-issue' blood transfusion service should replace this outdated concept.


METHODS
To assess this assumption, we carried out a retrospective analysis of 103 patients who underwent clipping or coiling during January to December 2001 in our Neurosurgical Unit.


RESULTS
All patients but one had been cross-matched (99%). However, only 33 patients (32%) eventually required a blood transfusion. In real terms, this meant a total of 294 units of blood that had been cross-matched routinely, in our series of 103 patients, were not used. Had these patients only been 'group and saved' and a system of 'fast-issue' been adopted, assuming that none of the patients had abnormal antibodies, the blood transfusion department would have made a saving of 4815.72 pounds sterling for this group of patients.


CONCLUSIONS
We conclude that advances in surgical technique have made routine cross-matching of blood in cerebral aneurysm surgery unnecessary.
de Gray
L C
LC
Addenbrooke's Teaching Hospital NHS Trust, Department of Neuroanaesthesia, Cambridge, UK.
Matta
B F
BF
D001788:Blood Grouping and Crossmatching / Q000191:economics*; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics*; D017046:Cost Savings; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D017721:Hospital Costs; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000191:economics / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000191:economics / Q000209:etiology / Q000601:surgery*
D006454:Hemoglobins