Evaluation of the effectiveness of preoperative blood ordering guideline in elective spine, knee replacement, and hip replacement surgery

Background: Preoperative blood ordering is necessary in most of the major orthopedic operations. However, over-crossmatching 200 units/day results in technician workload and compromises blood stock for other patients at Siriraj Hospital. Objective: To evaluate the effectiveness of a new blood ordering guideline in spine and arthroplasty surgery at Siriraj Hospital by comparing the quantity of blood ordering between pre-guideline and guideline groups. Material and Method: The guideline was developed from data of 456 patients who underwent spine or arthroplasty surgery between January 2013 and December 2013 at Siriraj Hospital. To evaluate the effectiveness of the guideline, blood order, and use in 89 patients who received specific orthopedic surgical procedures between December 2014 and March 2015 were compared to blood order and use in pre-guideline patients. Results: Five hundred forty five patients were included. Mean age of subjects was 58 years and 71.49% were females. Mean cross-matched units between the pre-guideline group (1.81 units; 95% CI 1.70 to 1.92) and the guideline group (1.34 units; 95% CI 1.13 to 1.55) was significantly different (p<0.001). Conclusion: The blood ordering guideline does increase effectiveness of preoperative blood reservation, reduce unnecessary cost, and does not compromise patient safety. Consistent use and frequent evaluation of this guideline are encouraged.