Routine preoperative blood group and save is unnecessary for adult emergency appendicectomies: A retrospective multicentre study

Abstract

Background and Aims Routine group and save (G&S) is commonly performed before appendicectomy despite limited evidence. This study aims to evaluate the necessity of preoperative G&S by determining perioperative blood transfusion rates. Methods A multicentre retrospective observational study of adult patients who had emergency appendicectomy across four hospitals between August 2018 and November 2020. Data analysed included demographics, operative details, G&S, crossmatching and perioperative blood transfusion. Results 1105 patients were identified, 635 (57.4%) were male. Median age was 37 years (IQR 26–52). 1012 (91.6%) were ASA 1 or 2. Surgical approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119 (10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804 (72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10 (0.9%) normal. 921 (83.3%) patients had preoperative G&S. 42 (3.8%) patients also had crossmatch. No patients required blood transfusion in 30 days post appendicectomy. The cost of G&S is estimated to be £40,164 in this cohort. Conclusions The need for perioperative blood transfusion is rare in patients undergoing appendicectomy. It has a significant cost impact and can cause unnecessary delays. Our study suggests that a routine G&S policy is not necessary, and we suggest a more ‘selective’ G&S policy.