Pre-operative group and save for elective total knee Arthroplasty: Is it indicated?

Abstract

Background: Total knee arthroplasty (TKA) is a commonly performed surgical procedure in UK. Routine use of tourniquets and tranexamic acid raises the question of whether pre-operative group and save (G&S) is necessary. Methods: Retrospective review of 100 patients who underwent TKA. We reviewed if G&S was performed as part of pre-operative assessment and cost of doing so, whether a tourniquet and tranexamic acid were administered, change in haemoglobin (Hb) concentration, and whether blood transfusion was required. We also investigated the time taken to provide type specific and fully cross-matched blood in an emergency, for patients with and without pre-operative G&S sample. Results: Tranexamic acid and tourniquets were used in all cases. Mean drop in Hb was 15.1 g/l. In 48-hour post-operative period, none of patients received any intraoperative blood transfusions. Conclusion: Pre-operative G&S results in only a minimal reduction in time to availability of blood products. In emergency situation, O negative blood can be administered immediately with or without a pre-operative sample. None of the cases required blood transfusion suggesting that pre-operative G&S represents a financial burden. There is minimal benefit to be gained from pre-operative G&S for elective TKA. Although further assessment is necessary, we advocate that G&S could be safely omitted.