Is Routine Group and Save Sampling Necessary for Emergency Laparoscopic Appendicectomy?

Abstract

Background Laparoscopic appendicectomy is a commonly used approach for the surgical management of acute appendicitis. If complications arise, a blood transfusion may be necessary for patients undergoing emergency appendicectomy. The need for routine group and save (G&S) sampling prior to emergency laparoscopic appendicectomy remains a subject of ongoing discussion. The aim of this study was to evaluate whether routine G&S sampling is needed prior to emergency laparoscopic appendicectomy. Methods The present study retrospectively reviewed G&S sampling for emergency laparoscopic appendicectomy cases over a six-month period at two hospital sites in the United Kingdom: Croydon University Hospital (June 1, 2024, to November 30, 2024) and Tunbridge Wells Hospital (October 1, 2023, to April 30, 2024). A total of 304 patients across both sites were included in the review. Results In 2023, 23 procedures (7.6%) were performed, while 279 procedures (92.4%) occurred in 2024. The patient population consisted of 46.4% males (n = 141) and 53.6% females (n = 163), with a mean age of 37.1 years (median 33, range 6-84). A total of 406 G&S samples were collected, of which 351 (86.5%) were processed and 55 (13.5%) were rejected by the blood bank. From the sample size, only one patient received a blood transfusion prior to surgery due to a low hemoglobin level of 72 g/L, likely resulting from the delayed presentation of a perforated appendix. Conclusion This study suggests that omitting routine G&S sampling is safe for patients undergoing emergency laparoscopic appendicectomy. Hence, an individualized risk assessment approach should be used to identify high-risk patients requiring preoperative G&S sampling.