Establishment of Maximum Surgical Blood Order Schedule (MSBOS) and Evaluation of Effective Blood Usage in Major Surgery / 대한수혈학회지

BACKGROUND: For effective blood usage and reduction of unnecessary workload at blood banks, we established the maximum surgical blood order schedule (MSBOS) for major elective surgeries and evaluated indicators, including the rate of returned red blood cells (RBCs). METHODS: During August 2016 and May 2017, MSBOS for neurosurgery, thoracic surgery, orthopedic surgery, and general surgery was established using two formulas: the mean units of transfusion per procedure (MSBOS 1) and the mean units of transfusion in transfused patients per procedure (MSBOS 2). The crossmatch to transfusion (C/T) ratio, transfusion probability, and rate of returned RBCs were calculated and analyzed. RESULTS: Based on MSBOS 1, type and screen can be applied to all elective surgeries of the general surgery department. MSBOS 2 was higher than MSBOS 1 in most surgeries ranging from 1 to 3 units. The C/T ratio and transfusion probability of surgery exhibited similar tendencies, and the general surgery department was over-prescribed compared to the actual transfusion requirement. The rate of returned RBCs was the highest in thoracic surgery (32/101, 32%), and the total number of returned RBC unit was the highest in orthopedic surgery (276 of 1131 units). CONCLUSION: MSBOS 1 was the formula corresponding to the purpose of the maximum blood application protocol. Application of an appropriate MSBOS protocol and concurrent utilization of C/T ratio, probability of transfusion, and rate and number of returned units of RBCs will further aid the efficiency of blood bank resources.

An Update of Maximum Surgical Blood Order Schedule in Elective Surgery / 대한수혈학회지

BACKGROUND: Recently, operation technology and health care environment are continuously improving and changing. An updated MSBOS using current blood usage data is necessary for efficient blood management in the hospital blood bank. METHODS: This study was a retrospective analysis based on operation names according to the ICD-9-CM at Severance hospital in 2013. We calculated the average units of red blood cells according to each operation, as well as the total units of RBCs used per each operation and patient. Finally an average unit of RBCs was set for the MSBOS, which were ordered before surgical operation. These analyzed results were compared with the previous reports of our hospital and other hospitals. RESULTS: Transfusion episodes occurred in 3,092 cases, which is only 8.6% of all patients. Total transfused units were 8,230 units, 27% of total RBCs (2,270 units) transfused were used in cardiovascular surgery. Compared with the previous data, the usage of RBCs during surgery was decreased. CONCLUSION: The MSBOS investigated in this study showed some differences in the indicators in 2007. Therefore, regular update of the MSBOS is necessary in each hospital to reflect the advancement of surgical technology.

Re-establishment of Blood Ordering Practice for Elective Surgery / 대한수혈학회지

BACKGROUND: The amount of blood components "on hold" preoperatively is usually determined by the surgeon's experiences or habits, and is often an amount in excess of the amount actually transfused. This method could diminish the effective use of blood components and result in an excessive workload for the blood bank, a shortage of blood products, and an increase in the quantity of discarded blood products. We quantified the amount of RBC components transfused during surgeries to establish the maximal surgical blood order schedule (MSBOS). METHODS: We analyzed the number of RBC component units transfused to patients >17 years of age who underwent elective surgeries performed at a university hospital between November 2005 and February 2007. RESULTS: There were 48,007 elective surgeries performed during the investigated period. The Departments of Surgery, Ophthalmology, Otolaryngology, and Urology carried out 8,317, 7,407, 5,928, and 5,268 surgical cases, respectively. The MSBOS values for 60 types of surgeries categorized into 7 surgical fields are listed. CONCLUSION: In the current study, we analyzed a greater number of surgical cases than previous studies in an effort to generate accurate and practical data. The mean amount of transfused RBC units was less in most types of surgeries compared to previous studies; this finding is presumed to be the result of improvements in surgical techniques and advances in medical science. A regular and comprehensive revision of the MSBOS is required to correspond to the changes in the medical environment and the shifting characteristics of patients, and to maximize the utility of blood products. A committee to supervise transfusion practices is also essential to coordinate different policies of the laboratory, surgical,and anesthesiology departments.

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.