Preoperative blood typing may not be needed for some pediatric surgeries

September 23, 2013

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" risk, according to the who reviewed the records of thousands of pediatric performed at The Johns Hopkins Hospital over 13 months.

Unnecessary pre-emptive -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 Fernández, M.D., a pediatric at All Children's Hospital Johns Hopkins Medicine in St. Petersburg, Fla. Fernández 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 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.

Calculating the odds that a child would require a blood transfusion against the number of actual transfusions performed and the number of pre-surgical blood tests done, the researchers determined that nearly one-third of children underwent excessive blood testing before their surgeries.

To avoid excessive or unnecessary testing, surgeons and anesthesiologists should assess each patient's specific needs for blood screening in light of the team's findings rather than order these tests as a knee-jerk reflex, the researchers say.

Hospitals with electronic medical record systems should take advantage of the rich pediatric surgery data captured in their databases and use that information to devise cost-cutting strategies that save precious resources without compromising patient safety and outcomes, the team says.

Recent advances in surgical techniques and new minimally invasive approaches have made many operations safer and less invasive, reducing and the need for transfusion, the investigators say.

"The moral of the story here is that times have changed and we transfuse less than we have in the past, so now we find that quite a few children undergo unnecessary blood-typing and cross-matching before common surgeries," says study senior investigator Eugenie Heitmiller, M.D., a pediatric anesthesiologist at the Johns Hopkins Children's Center. "These results tell us we should really pause and re-examine this practice."

Researchers say this is study the first of its kind in pediatric patients in that it used actual clinical data rather than surgeons' reports.

Other researchers involved in the study were Jessica Cronin, M.D., and Robert Greenberg, M.D.

Explore further: Researchers rewrite obsolete blood-ordering rules

Related Stories

Researchers rewrite obsolete blood-ordering rules

May 22, 2013
Johns Hopkins researchers have developed new guidelines—the first in more than 35 years—to govern the amount of blood ordered for surgical patients. The recommendations, based on a lengthy study of blood use at The Johns ...

Blood transfusions still overused and may do more harm than good in some patients

April 24, 2012
Citing the lack of clear guidelines for ordering blood transfusions during surgery, Johns Hopkins researchers say a new study confirms there is still wide variation in the use of transfusions and frequent use of transfused ...

Drug treatment means better, less costly care for children with sickle cell disease

September 11, 2013
The benefits of hydroxyurea treatment in people with sickle cell disease are well known—fewer painful episodes, fewer blood transfusions and fewer hospitalizations. Now new research from the Johns Hopkins Children's Center ...

Risk of blood loss in childhood back surgery varies with cause of spine deformity

April 9, 2012
(Medical Xpress) -- The relative risk of blood loss during corrective spine surgery in children appears linked to the underlying condition causing the spinal deformity, according to a new study from Johns Hopkins Children’s ...

New, more efficient blood-ordering guidelines issued

June 11, 2013
(HealthDay)—By extracting blood utilization data from electronic medical records and applying it to a proposed algorithm, a cost-saving, institution-specific maximum surgical blood order schedule (MSBOS) can be created, ...

More central line infections seen in children with cancer once they leave the hospital

July 24, 2013
Pediatric cancer patients whose central lines are used to treat them at home develop three times as many dangerous bloodstream infections from their devices than their hospitalized counterparts, according to the results of ...

Recommended for you

Hold the phone: An ambulance might lower your chances of surviving some injuries

September 20, 2017
Victims of gunshots and stabbings are significantly less likely to die if they're taken to the trauma center by a private vehicle than ground emergency medical services (EMS), according to results of a new analysis.

Surgeons have major influence on breast cancer treatment

September 13, 2017
A woman's choice of surgeon plays a significant role in whether she's likely to receive an increasingly popular aggressive breast cancer surgery.

Some thyroid cancer patients can safely delay surgery

September 4, 2017
Most people diagnosed with cancer want to start treatment as soon as possible, for fear that delaying care will allow their tumor to grow out of control.

Obese people lack cells with satiety hormones

August 29, 2017
Individuals with severe overweight have an inhibited sense of satiation - they release fewer satiety hormones than people of normal weight. The reason: the responsible cells in the gastrointestinal tract of obese people are ...

Anesthesia and surgery during infancy may impact white matter during childhood

August 24, 2017
General anesthesia and surgery in otherwise healthy infants under the age of 1 year old could be associated with decreases in the amount of white matter in the brain, as well as reductions in the remaining white matter's ...

Smoking raises risk of aneurysm recurrence after endovascular treatment

August 17, 2017
In a new study, researchers report people who have experienced an aneurysm have another reason to quit smoking.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.