Establishment of the maximum surgical blood order schedule for cesarean sections / 中国输血杂志

【Objective】 To establish the catalog of maximum surgical blood order schedule(MSBOS) for cesarean sections with different obstetric complications, so as to guide the doctors of clinical and Blood Transfusion Department to prepare blood reasonably. 【Methods】 The blood transfusion data during cesarean sections from January to October 2021 in our hospital were collected via medical record information system and blood bank system.The blood recipients were classified according to the main obstetric complications. The incidence of blood transfusion, per capita RBC transfusion units, blood transfusion index (TI) and other indicators were calculated, the literature and the risk of massive hemorrhage were referred, and the actual situation of Obstetrics Department was considered to formulate the obstetric MSBOS of our own. 【Results】 1) The blood recipients during cesarean sections were mainly diagnosed as placental abruption, placental implantation, central placenta previa and severe preeclampsia; the incidence of blood transfusion of them was 17.9%(20/112), 17.7%(15/85), 16.8% (27/161)and 5.2%(9/173), respectively, and TI indexes was 0.9, 1.3, 1.0 and 0.3, respectively. 2) The MSBOS of Obstetrics Department in our hospital had been established, and the blood preparation for obstetric surgery was divided into three categories: T(blood typing)/S(antibody screening), T(blood typing)/S(antibody screening)/C(crossmatch) 2 U, and T/S/C 4 U. 【Conclusion】 The establishment of MSBOS in Obstetrics Department of our hospital provides references for preparing blood reasonably.

Survey of Maximum Blood Ordering for Surgery (MSBOS) in elective general surgery, neurosurgery and orthopedic surgery at the Poursina Hospital in Rasht, Iran, 2017

ABSTRACT Introduction: Blood is a valuable life resource that depends on the donation of blood by the community. As a result, it is crucial that the manner in which this expensive resource is used be correct and reasonable. Objective: The purpose of this study was to investigate the Maximum Blood Ordering for Surgery (MSBOS) in general, orthopedic and neurosurgical elective surgeries at the Poursina Hospital in Rasht in 2017. Methods: According to the patient file number information, such as gender, age, type of surgery, number of blood units requested, number of cross-matched blood units, number of blood units transfusion, number of patients undergoing transfusion, number of patients who were cross-matched, initial hemoglobin and the underlying disease, was extracted from the HIS (Hospital Information System). Based on the collected data, a descriptive report of the cross-match to transfusion ratio (C/T), transfusion index (TI) and transfusion probability (%T) was performed, using average and standard deviation, by using the SPSS 16. Results: In the present study, 914 patients from the neurosurgery, orthopedic and general surgery wards of the Poursina Hospital were studied. Of these, 544 were male (59.5%) and 370 were female (40.5%), aged 1-99 years, with a mean age of 43 years. The frequency distribution of C/T in this study was 1.29 in neurosurgery, 1.95 in orthopedic surgery and 1.96 in general surgery. This study indicated that the C/T index was above the normal standard level in four different kinds of surgery, including leg fracture (2.71), cholecystectomy(2.71), forearm fracture (2.70), and skin graft (2.62).The C/T index was at the maximum normal level in thyroidectomy surgery (2.5). The other surgeries had the normal C/T index. Conclusion: Overall, all of the MSBOS indices were at the standard level in this study, although C/T indices were higher than the standard level in the surgeries for cholecystectomy, leg fracture, forearm fracture, hand fracture and skin graft.

Analysis of orthopedic surgical blood transfusion and study on maximum surgical blood order schedule / 中国输血杂志

【Objective】 To establish the maximum surgical blood order schedule(MSBOS) for orthopedic surgery, as to guide the clinical blood application and reasonable blood preparation for this type of surgery. 【Methods】 The ordered and actual amount of transfused blood of orthopedic elective operations in our hospital from 2014 to 2018 were collected by the hospital information(HIS) and blood collection information software of Department of Blood Transfusion.The surgeries were classified and indices, including blood transfusion rate and per capita transfused RBC volume, were calculated, then orthopedic MSBOS was established by combining the surgical transfusion rate, per capita red blood cell infusion volume, the algorithm of MSBOS, the risk of massive hemorrhage and the actual situation of our hospital. 【Results】 A total of 3 730 cases of elective orthopedic surgery were included, and the ordered blood volume was 10 183.8 U. 1084 cases received intraoperative blood transfusion, with the total blood transfusion volume of 3 498.8 U and the blood transfusion rate at 29.1%(1 084/3 730). The blood transfusion volume of surgical patients was [1~17.5(3.21±1.89)] U/patient. MSBOS for orthopedic surgeries had been established in our hospital. According to the blood transfusion data of each surgical procedures, surgical blood ordering was divide into 2 categories: Type/Screen, Type/Screen/Crossmatch (2~8 U). 【Conclusion】 The establishment of MSBOS in Department of Blood Transfusion according to the daily blood use in orthopedic surgery is not only beneficial to guide the blood preparation for orthopedics surgery more scientifically and reasonably, but also can optimize the management of blood inventory and provide reference for the establishment of MSBOS in other blood use departments.

Can Maximum Surgical Blood Order Schedule Be Used as a Predictor of Successful Completion of Bloodless Surgery?

BACKGROUND: The Soonchunhyang University Hospital Bloodless Center was established in 2000, and more than 2,000 bloodless surgeries have been performed there since. In this study, the lowest postoperative Hb/preoperative Hb (Hblow/pre) ratio and mortality rates of patients who underwent bloodless surgery were analyzed for each maximum surgical blood order schedule (MSBOS) category to assess whether MSBOS can be used as a predictor of successful completion of bloodless surgery. METHODS: A total of 971 patients were included. MSBOS was defined as the average number of units of RBCs transfused during each elective surgery. We used the Hblow/pre ratio as an alternative to intraoperative blood loss. Frequency of Hblow/pre ratios < or =0.5, use of transfusion alternatives, and mortality rates were compared across MSBOS categories. RESULTS: Out of the 971 patients, 701 (72.2%) were categorized as type and screen (T&S), 184 (18.9%) as MSBOS 1, 64 (6.6%) as MSBOS 2, and 22 (2.3%) as MSBOS 4. Transfusion alternatives were used by 397 (40.9%) patients. The frequency of the use of simultaneous erythropoietin and iron, hemostatics, acute normovolemic hemodilution, and Cell Saver (Haemonetics corp., USA) was higher in patients in the higher MSBOS categories. Six (0.6%) patients died within 30 days of surgery. Hblow/pre ratios tended to be lower as the level of MSBOS category increased. CONCLUSIONS: Surgeries in the higher MSBOS categories tended to be associated with high blood loss and mortality. Active use of transfusion alternatives is recommended in patients in high MSBOS categories who are scheduled to undergo bloodless surgery.

Evaluation of an Automatic Cancellation Program to Reduce Wastage of Blood Components / 대한수혈학회지

BACKGROUND: Ordering an excessive quantity of blood for elective surgery beyond the actual need causes unnecessary cross-matching and wastage or shortage of blood products. To prevent this problem, a maximum surgical blood order schedule (MSBOS) is beneficial. However, the application of a MSBOS is limited due to the complexity of accurate classification based on the name of the operation alone. In this study, we introduced an automatic cancellation program, in which the assigned blood is automatically cancelled after a certain period of time, andevaluated the practicality of a revised MSBOS. METHODS: We analyzed our hospital data involving transfused RBCs for each elective surgical procedure performed between January and June 2007. The MSBOS was organized based on the average number of units of RBCs transfused for the types of surgeries that had been performed >50 times during a certain period of time. The blood cancellation ratio, blood wastage ratio, and the causes of blood wastage were compared before and after adopting the automatic cancellation program and the revised MSBOS. RESULTS: After adopting the automatic cancellation program, the blood cancellation ratio decreased from 18.3% to 17.6% and the blood wastage ratio decreased from 2.67% to 2.00%. There was no significant change with respect to the causes of blood wastage before and after adoption of the automatic cancellation program. CONCLUSION: The implementation of an automatic cancellation program facilitates the efficient use of blood products during elective surgery. It would be useful to apply a revised MSBOS continuously, which is easily applicable and practical in order to decrease the blood wastage rate.

Organization of Maximum Surgical Blood Order Schedule (MSBOS) according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) / 대한수혈학회지

BACKGROUND: The aim of this study is to organize the maximum surgical blood order schedule (MSBOS) of red blood cells (RBCs) for elective surgeries according to the International Classification of Diseases, Ninth Revision, Clinical Modification guidelines (ICD-9-CM) and we compared the results with the previously reported MSBOSs. METHODS: From 1 March to 31 August 2007, the data of the transfused RBCs for elective surgeries in our hospital were analyzed. The MSBOS was organized as the average number of units of transfused RBCs for the type of surgery, according to the ICD-9-CM. The results were compared with the MSBOSs that were previously reportedfrom 1982 to 2004 in Korea. RESULTS: A total of 121 types of 3,375 surgeries were performed. Type & screen for 91 types (81.3%), 1 unit for 20 types (13.8%), 2 units for 7 types (3.8%), 3 units for 1 type (0.4%) and 4 units for 2 types (1.8%) were recommended. There was a minimal difference between these results and the range for the previously reported MSBOSs. CONCLUSION: It seems that the MSBOS showed minimal change since 2004. We organized the MSBOS according to the guidelines of the ICD-9-CM. Standardization of the surgery name should be considered to achieve more useful utilization of MSBOS.

The Amount of Blood Use and Reorganization of Maximal Surgical Blood Order Schedule (MSBOS) in Elective surgery / 대한수혈학회지

BACKGROUND: Overpreparation of Red Blood Cells for elective surgery causes problems, such as returning of blood, inefficient task of the blood bank and waste of blood resources. At The National Medical Center, Maximal Surgical Blood Order Schedule(MSBOS) was organized for the first time in 1994. Recently, blood use is decreased as various transfusion side effects become known, and operation technique and anesthetic methods develop. As a result, we try to revise MSBOS investigating RBC utilization for elective surgery in 2002. METHODS: We investigated RBC utilization for elective surgery, the number of transfused patient, mean blood amount of all patient having been operated in. It was accomplished by referring to anesthesiologic records and blood delivery sheet at The National Medical Center during the 12 months from January through December in 2002. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For one year, the total number of surgery was 3,204, and transfusion was done in 1095 cases of surgery. Average transfusion rate is 34.4%. In 8 kinds of surgery(275 case, 9.3%), average amount of transfusion was under 0.5 unit and Type and Screen(T&S) is transduced for the elective surgery. Except for Cesarean section(C/S), blood use is decreased significantly, compared with the MSBOS organized at 1994. CONCLUSION: We could revise the guidelines for ordering blood on the basis of above results. And MSBOS should be revised at regular intervals, which can decrease blood disuse and medical cost.

Suggestion of Maximum Surgical Blood Order Schedule for Major Elective Surgeries in Korea / 대한수혈학회지

BACKGROUND: There have been many efforts to determine maximum surgical blood order schedule (MSBOS) of elective surgery in Korea since 1980?. But most of these data were confined to single hospital, so it was somewhat irrelevant to suggest them as general data in Korea. In this study, we tried to establish MSBOS which can be suggested as substantial and objective data in our country and to increase the efficiency of limited blood products. METHODS: From September 2003 to February 2004, we analyzed average RBC utilization for elective surgery in four university hospitals (Soonchunhyang University Hospital, Soonchunhyang University Bucheon Hospital, Korea University Ansan Hospital, Ajou University Hospital) by referring to anesthesiologic records and blood delivery sheets. Also, we established MSBOS range in operations performed more than five times in three among four hospitals. RESULTS: Sixty-seven operations were analyzed in our study and 18 of them were performed in department of general surgery. Type and screen (T&S) was recommended in 69.8~83.6% and the percentage of operations recommended as T&S in all four hospitals was 52.2%. Operations of obstetric/gynecology, urology and otorhinolaryngology were mostly applicable to T&S. CONCLUSION: We suggested comprehensive and substantial MSBOS range by analyzing the operations performed in four hospitals whose operation numbers ranged from 470 to 1,200 per month. It was considered that MSBOS range, which could be applicable to various hospitals, should be reestablished and enforced regularly to decrease medical cost and improve blood utility

Analysis of Surgical Blood Use and Determination of Maximum Surgical Blood Order Schedule at Dankook University Hospital / 대한수혈학회지

BACKGROUND: The aim of our study is to determine maximum surgical blood order schedule (MSBOS) in elective surgery through analyzing usage of blood products such as packed red cells and whole blood at Dankook University Hospital. We would like to establish the guidelines for effective utilization of blood products by introducing MSBOS to our hospital. METHODS: We calculated average amount of transfused blood for each elective surgery based on the discharge records of patients from January 1997 to December 1998 at Dankook University Hospital. Only those operations performed more than 5 times were included in this study. Average number of transfused units per patient of each operation was selected for MSBOS. RESULTS: For two years, the total number of surgery was 15,497 and the number of transfused operations was 1,682 (10.85%). Operation groups transfused below 10% was 77.3% of all 199 operation groups. The number of operation groups whose average of transfused blood was below 0.5 units was 80.3%. Type and screen (T&S) was recommended in 140 (70.4%) of all the operation groups. Of total groups MSBOS of 2 units was estimated in 4 groups (2.0%), of 3 in 14 groups (7.0%), 4 of 4 groups (2.0%), 5 of 2 groups (1.0%), 6 of 4 groups (2.0%), 7 of 7 groups (3.5%), and 8 in 2 groups (1.0%), respectively. CONCLUSION: We established MSBOS through the previous transfusion data of surgical operations over two years. To enforce MSBOS is needed for better medical services, which would decrease blood disuse and medical cost.

Analysis of Effectiveness of the Maximum Surgical Blood Order Schedule / 대한수혈학회지

BACKGROUND: The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. In this study, we showed the process establishing MSBOS and through a prospective study, we evaluated the efficacy of MSBOS. METHODS: We organized task force team for transfusion management improvement composed of a director of the blood bank, surgeons and anesthesiologists in the Committee for Quality Improvement (CQI) of Asan Medical Center. In this team, we established MSBOS for most elective surgeries through the review of the previous transfusion and crossmatching data. We introduced MSBOS in April 1998 and prospectively analyzed surgeon's acceptance rate of MSBOS, crossmatch-to-transfusion ratio (C/T ratio), blood wastage rate, and cost savings. RESULTS: During the first 19 months after introducing MSBOS at our hospital, there was gradual increase in the surgeon's compliance rate of MSBOS from 30% to 94.0% through continuous education. The C/T ratio was changed from 3.5 to 1.6 and blood wastage rate was decreased from 4.0% to 1.9%. And also we could save more than 38,400,000 won through not performing the unnecessary crossmatches of 7,680 cases per year. CONCLUSION: Introduction of MSBOS can have a significant impact in reducing C/T ratio, blood wastage rate, and unnecessary crossmatches for the unused blood units. For successful application of MSBOS, cooperation with surgeons and anesthesiologists and continuous education is essential.

Reorganizatin of Blood Ordering Practice for Elective Surgery / 대한임상병리학회지

BACKBROUND: The over-preparation of blood for elective surgery causes some problems such as returning of blood, inefficient task and loss of reagent. Even though "Type & Screen" method helps solve such problems, we need to make a great effort to inform clinician of it. In Severance hospital, 1986 MSBOS had been established for the first time and revised in 1991. Recently, as various side effects of transfusion have been known and operation technique developed, blood usage is being decreased. Therefore, we try to revise maximal surgical blood order schedule(MSBOS) investigating RBC utilization for elective surgery in Severance hospital, 1999. METHODS: We investigated RBC utilization for elective surgery of the adult patient and, pre-op hemoglobin level, number of transfused patients, mean blood amount of transfused patients and mean blood amount of all operated patient referring to anesthesiologic record and blood delivery sheet in Severance hospital during 6 months from January through June 1999. RESULTS: The blood utilization of the period has been significantly decreased, compared with the previous reports(Korean J Blood Transfusion 1991;2:183-90) except in cardiovascular surgery. CONCLUSIONS: We could revise the guidelines for ordering blood on the basis of above results. Afterthis, MSBOS should be reestablished at regular intervals to improve blood utility.