Is a Preoperative Type and Screen Required in Patients Undergoing Common Urological Procedures? A Cost-Benefit Analysis
Joshua R. Volin, B.S.1, Patrick Herndon, B.S.1, Aviv Spillinger, B.S.1, Patrick Karabon, M.S.1, James Blumline, B.S.1, Deanna Tran, B.S.1, Craig Fletcher, M.D.2, Jason Hafron, M.D.2.
1Oakland University William Beaumont, Royal Oak, MI, USA, 2Beaumont Hospital - Royal Oak, Royal Oak, MI, USA.
BACKGROUND: Our objective was to evaluate the cost-effectiveness of obtaining preoperative type and screen (TS) for common urological procedures and to determine patient and hospital factors associated with receiving blood transfusions.
METHODS: Retrospective database analysis of the 2006-2015 Nationwide Inpatient Sample (NIS) was performed to identify patients undergoing a variety of urological procedures. A total of 4,113,144 cases were identified. Transfusion rates were then determined from NIS data, and multivariate regression analyses was used to identify factors associated with transfusions. A cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative TS to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.
RESULTS: Transfusion rates of common urological procedure ranged from .91% to 33.14%. On multivariate modeling, all comorbidities with the exception of obesity were significantly associated with blood transfusion. Some examples included diabetes (OR, 1.26; 95% CI, 1.19-1.33), liver disease (OR, 1.20; 95% CI, 1.13-1.29), and metastatic cancer (OR, 2.69; 95% CI 2.54-2.85) (p < 0.01 for all). One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative TS. The ICER of preoperative TS for radical prostatectomy (transfusion rate = 3.88%) and penile implants (transfusion rate = 0.91%) were $1,607 and $7,709 per ERT prevented, respectively.
CONCLUSIONS: Based on a large national database, institutions should consider a risk of transfusion greater than or equal to 4.12% to justify a preoperative TS. A selective TS policy for high risk patients may reduce costs and unnecessary workload for laboratory staff.
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