title: Is a preoperative group and save necessary for enhanced recovery joint replacement patients?
abstract: OBJECTIVE
  To consider the financial benefit to the authors' trust of omitting a preoperative group and save in enhanced recovery arthroplasty patients, and to estimate the scope for national savings. Patient safety was considered to determine acceptability for routine practice.
  
  
  METHODS
  A total of 121 patients receiving a total knee replacement or total hip replacement on the authors' enhanced recovery protocol were selected. Pre- and postoperative haemoglobin levels were obtained. The transfusion team were contacted when the postoperative haemoglobin level was ≤8 g/dl to determine whether blood products had been issued. Costs for group and save were obtained from the pathology department.
  
  
  RESULTS
  Mean postoperative reduction in haemoglobin level was 2.6 g/dl (P≤0.001) and 2.1 g/dl (P≤0.001) for total hip replacement and total knee replacement respectively. No patients were transfused. One group and save costs £12.00, and omission of this test in these patients would have saved £1452.00. Potentially, £1 605 408 could have been saved in the 133 784 patients undergoing NHS arthroplasty in 2012. Group and save omission would not affect management of intraoperative haemorrhage where O negative blood would be available. If a transfusion is required postoperatively it would take 100 minutes to issue crossmatched blood - a time delay unlikely to compromise patient safety.
  
  
  CONCLUSIONS
  These results suggest that a preoperative group and save could be omitted in arthroplasty patients on this enhanced recovery programme to prevent needless expenditure, but more long-term follow up is required to ensure patients are not put at risk.
authors.affiliation: FY1 in the Department of Ear, Nose and Throat Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Metcalfe
authors.forename: Malwattage L T
authors.initials: ML
authors.lastname: Jayatilaka
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Cope
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001788:Blood Grouping and Crossmatching / Q000191:economics*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D057725:Operative Blood Salvage / Q000191:economics*; D011300:Preoperative Care / Q000191:economics; D006113:United Kingdom