title: A study of pre-operative type and screen in breast surgery: improved efficiency and cost saving.
abstract: BACKGROUND
  Patients undergoing major breast surgery have an almost negligible need for blood transfusions. However, type and screen requests are still routinely performed. This represents an inefficient utilization of resources and unnecessary workload for laboratory staff. The aim of this study was to ascertain whether pre-operative blood typing is justified in patients undergoing surgical procedures with an intermediate transfusion probability.
  
  
  METHODS
  A retrospective analysis of all patients undergoing a mastectomy and axillary clearance, with or without breast reconstruction in the last 2 years was undertaken. The number of group and hold and cross-match samples that were performed were identified and compared to the number of patients requiring a blood transfusion. The overall cost of routine pre-operative blood typing was analysed.
  
  
  RESULTS
  A total of 229 patients were identified. Of these, a group and hold was performed on 192 (83.8%) patients. Cross-matching was undertaken in thirty-one patients (13.5%). In total, five patients (2.1%) required transfusion. No patient was transfused intra-operatively. The overall cost of routine group and hold blood requests was 1,920 euros and of pre-operative cross-matching was 465 euros. Forty-seven units of blood was returned unused to the blood transfusion service at an estimated cost of 23,500 euros.
  
  
  CONCLUSIONS
  The need for routine group and hold blood requests is not justified for patients undergoing elective breast surgery and represents a waste of clinical resources. A more targeted approach will not only reduce the demand on blood products but also reduce the associated costs to blood transfusion services.
authors.affiliation: Surgical Professorial Unit, Department of Surgery, University College Hospital Galway, Galway, Ireland. ruthprichard@rcsi.ie
authors.forename: R S
authors.initials: RS
authors.lastname: Prichard
authors.forename: M
authors.initials: M
authors.lastname: O'Keefe
authors.forename: R
authors.initials: R
authors.lastname: McLaughlin
authors.forename: C
authors.initials: C
authors.lastname: Malone
authors.forename: K J
authors.initials: KJ
authors.lastname: Sweeney
authors.forename: M J
authors.initials: MJ
authors.lastname: Kerin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001788:Blood Grouping and Crossmatching / Q000191:economics* / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000191:economics* / Q000706:statistics & numerical data*; D001940:Breast / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D016462:Mammaplasty; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D057234:Preoperative Period; D011336:Probability; D012189:Retrospective Studies