Is Cross-Matching Required? Analysis of Blood Transfusion in Gynecological Surgeries at an Academic Hospital in Bangkok, Thailand: A Cross-Sectional Study.

BACKGROUND AND AIMS: Effective utilization of perioperative blood transfusions can reduce costs and minimize blood waste. This study aimed to audit the appropriateness of current blood utilization practices in gynecological surgeries, characterize transfusion rates, and identify associated risk factors for transfusion.

MATERIALS AND

METHODS

A retrospective, cross-sectional study was conducted from January 2021 to October 2023, involving 2394 patients who had perioperative blood requests and underwent gynecological surgeries in the Departmental Theatres at Ramathibodi Hospital. Patient characteristics and clinical profiles, particularly the quantities of packed red blood cells (PRC) requested and utilized, were reviewed. The appropriateness of blood utilization in gynecological surgeries was calculated using standard parameters, including the cross-match-to-transfusion (C/T) ratio, transfusion probability (TP), and transfusion index (TI). Descriptive, univariate, and multivariate analyses were employed.

RESULTS

Of 2394 gynecological surgeries, 431 (18%) patients had cross-matching requests, while only 113 (4.7%) were transfused. Appropriate blood utilization was revealed by indices, with a C/T ratio of 2.43 and a TI of 0.60. 90.3% of transfusion events were administered in elective settings. Using univariable analysis, the data demonstrated that age, baseline hemoglobin, operative time, blood loss, previous abdominal surgeries, including myomectomy and endometriosis-related surgeries, cardiovascular comorbidities, and current antiplatelet/anticoagulant use were independently associated with perioperative blood transfusion. However, only three variables significantly remained on multivariable analysis, including baseline hemoglobin (adjusted odds ratio [aOR]: 0.608; 95% confidence interval [CI]: 0.519-0.709), operation duration (aOR: 1.004; 95% CI: 1.001-1.007), and blood loss (aOR 1.003; 95% CI: 1.003-1.004).

CONCLUSION

The study reveals appropriate blood utilization in gynecological practices. Other than in cases of active hemorrhage or anticipated extensive surgery, routine cross-matching may be unnecessary in elective low-risk procedures. Tailored approaches are necessary for specific indications or procedures with a high likelihood of requiring blood transfusion.