Introduction of a Standard Operating Procedure to Reduce Routine Group and Saves Prior To Emergency Appendicectomy

Tanvi Khetan, Ee Teng Goh, Momotaz Sultana

Appendicectomy, Group and Save, Transfusion, Laparoscopy

Introduction: acute appendicitis is the most common abdominal surgical emergency. Laparoscopic appendicectomy is the gold standard of care in management (78% in 2010)^[1]. Major vessel injury is historically reported at around 0.07-0.12%^[2]-[5], and is usually associated with a closed approach to pneumoperitoneum induction. Despite lack of national/international guidance or formalised risk stratification protocols in the literature, routine practice often includes group and save samples to be taken pre-operatively for all patients.

Methods: An audit of appendicectomies was undertaken on patients discharged between 1 January 2020 – 31 December 2020. The primary outcome was incidence of perioperative blood product transfusion, up to 30 days from index admission. A standard operating procedure was developed and reaudit data was undertaken from 1 July 2022 – 31 August 2022.

Results: Of 202 appendicectomies, only one patient required blood transfusion. This was given on day four post-index operation. No patients involved intraoperative major vessel injury and blood transfusion. Re-audit showed reduction of routine group and saves being taken from 98% to 65% with no patients requiring blood transfusion.

Conclusion: Our study suggest that it is safe to cease a blanket requirement for preoperative group and saves with an agreed standard operating procedure with overall reductions of up to 72%.

https://doi.org/10.31871/WJRR.16.2.10