The health economics of blood use in cerebrovascular aneurysm surgery: the experience of a UK centre

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SummaryBackground and 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that a simple ‘group and save’, coupled with a reliable ‘fast-issue’ blood transfusion service should replace this outdated concept.Method:To assess this assumption, we carried out a retrospective analysis of 103 patients who underwent clipping or coiling during January to December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 for this group of patients.Conclusion:We conclude that advances in surgical technique have made routine cross-matching of blood in cerebral aneurysm surgery unnecessary.

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