Abstract
Efficient perioperative blood management is vital to reduce wastage. Using tools such as the surgical blood order equation (SBOE) and regularly reviewing preoperative blood preparation volumes owing to advancements in surgical techniques and evolving management strategies are crucial. This study evaluated the use of red cell concentrates (RBCs) in oral and maxillofacial cancer surgeries at our institution and retrospectively assessed the adequacy of blood preparation.
Between April 2019 and August 2022, we analyzed oral malignant tumor surgeries lasting more than 8 hours. We evaluated the quantities of RBCs prepared, utilized, and discarded. Patient-specific RBC preparation was calculated using the SBOE, factoring in average blood loss and preoperative hemoglobin (Hb) levels, and compared with the actual amount of RBCs prepared. Preoperative RBC preparation occurred in all 27 cases (2 units in 5 cases, 4 units in 22 cases). A total of 98 RBC units were prepared during the study, with 22 units discarded, resulting in a 21％ discard rate. SBOE analysis showed that RBCs were over-prepared in 22 of the 27 cases. RBCs were transfused intraoperatively in 17 out of 27 cases (63％), with several transfusions given despite Hb levels exceeding 8 g/dL. Following these findings, the RBC preparation volume was reduced to 0–2 units, which led to a lower transfusion rate (2 out of 8 cases : 25％).
Identifying excessive RBC preparation through SBOE analysis can help reduce blood resource wastage and prevent unnecessary transfusions. Regularly reviewing and tailoring RBC preparation protocols using methods such as SBOE may enhance transfusion optimization.
