Certain pediatric surgeries carry such low risk of serious blood loss that clinicians can safely forgo expensive blood typing and blood stocking before such procedures, suggest the results of a small study by researchers at the Johns Hopkins Children's Center.
The finding, published ahead of print in the journal Pediatric Anesthesia, was accompanied by a list of 10 operations with "zero" transfusion risk, according to the investigators who reviewed the records of thousands of pediatric surgeries performed at The Johns Hopkins Hospital over 13 months.
Unnecessary pre-emptive blood-type testing and blood stocking can not only inflate the overall cost of care, but squander vital supplies when any unused blood expires and cannot be restocked for future use, the researchers say.
"We knew anecdotally that just-in-case blood typing and ordering are often unnecessary and wasteful but we wanted to know precisely when we may be able to safely skip them," says study lead investigator Allison Fern-ndez, M.D., a pediatric anesthesiologist at All Children's Hospital Johns Hopkins Medicine in St. Petersburg, Fla. Fern-ndez conducted the research as a pediatric anesthesiology fellow at the Johns Hopkins Children's Center in 2012.
The research showed that blood transfusions were not needed in more than 97 percent of the 8,620 pediatric non-cardiac surgeries performed at Johns Hopkins during the study period. Of the 8,380 patients for whom a transfusion was unnecessary, 707 underwent preliminary blood typing and 420 of them underwent additional cross-matching, a procedure in which the recipient's blood is further tested for compatibility with the donor's blood. In 10 cases, the pre-ordered blood units reached a temperature that made them unsafe for future use and were thrown away. The total price tag for the additional tests and unused blood was nearly $60,000, the researchers say.
The Johns Hopkins team mined the data to identify procedures least likely to require transfusions and discovered 10 that never did, yet children were commonly tested before them. The list includes some common surgeries of the colon and spinal cord, lumbar punctures, central line placements, a type of laparoscopic procedure used to treat gastro-esophageal reflux and hiatal hernia, and a brain operation for Chiari malformation that involves making a small incision in the back of the skull. Also on the list: a hip-imaging procedure known as an arthrogram, repairs of a dislocated or fractured elbow and tonsil and adenoid removal.
Two additional procedures - a surgery to reposition a catheter that drains excess cerebrospinal fluid from the brain into the abdomen and an operation performed in some scoliosis patients - carried an extremely small risk of blood transfusion.