Group and Spend: An Evaluation of Perioperative Group and Save Practices in Traumatic Forearm, Wrist, Hand, Foot and Ankle Fracture Fixations and Their Associated Costs

Abstract

Background Fractures of the peripheral limbs make up a significant proportion of the caseload seen by an Orthopaedic Department. Some of these fractures will require surgical intervention and typically undergo open reduction and internal fixation (ORIF). Current guidance states that patients undergoing such procedures do not require group and save testing prior to theatre. Despite this, many patients still undergo these tests, which are seldom utilised to facilitate intraoperative or postoperative transfusion. Aim This article sets out to determine the incidence of group and save testing performed within a tertiary trauma service, as well as the rate of transfusions observed and any potential relationship with pre-operative haemoglobin as a predictor of transfusion. The financial cost of performing group and save tests, outwith current guidance, will also be determined to assess the financial impact on the trust. Methodology A three-month retrospective cohort analysis was conducted, utilising theatre planning records from June 1, 2024, to August 31, 2024, to identify patients undergoing single-procedure ORIFs of the forearm, wrist, hand, ankle or foot. Each patient’s electronic patient record was then examined to determine age, sex, pre-operative haemoglobin concentration, number and date of group and save tests, and whether they were issued or received blood products. The individual cost of one group and save test was found through enquiry with the local blood transfusion laboratory as £10.77. Results There were 117 patients who underwent 118 distal limb ORIFs and a total of 105 group and save samples sent. The mean pre-operative haemoglobin was 132.5 g/L, with a minimum observed haemoglobin of 94 g/L. No patient received blood products intraoperatively or postoperatively. The total cost of group and save testing in the period observed was found to be £1,130.85. The projected annual cost of the group and save testing for this cohort was £4,523.40. Conclusion This study finds that, despite local and national guidance, a significant number of group and save tests are being conducted unnecessarily, at significant cost to the trust. There is no relationship observed between pre-operative haemoglobin and transfusion requirement, which confirms that current guidance is appropriate. Increasing adherence to current policy is projected to save the trust up to £4,523.40 annually. It is recommended that other centres audit their use of pre-operative testing for appropriateness, utility and cost.