Evaluating the necessity of pre-transfusion testing in primary total hip arthroplasty: a systematic review and meta-analysis.

Abstract

Introduction: The unnecessary over-ordering of routine pre-transfusion tests (blood typing, screening, and cross-matching) for surgical cases results in substantial avoidable costs and imposes an undue burden on transfusion services. This study specifically focuses on conducting a systematic review of the literature to assess the necessity of routine pre-transfusion tests before total hip arthroplasty (THA) and aims to provide a comprehensive summary of the outcomes associated with this practice.

Methods: A systematic review and meta-analysis were conducted to analyse the study's characteristics, assess the prevalence of over-ordering, defined as ordering more routine pre-transfusion tests than clinically necessary, examine transfusion rates, and evaluate potential cost savings to the healthcare system.

Results: The study included 12,178 patients. Pooled results revealed an 88.1% over-ordering pre-transfusion test rate (95% CI, 0.80-0.96; p < 0.001) among patients undergoing primary THA. The pooled prevalence of hospital transfusion rate was 11.9%, with a percentage of intraoperative transfusion of 0.4% (95% CI, 0.001-0.007; p = 0.007). There were statistically significant differences in preoperative haemoglobin (Hb) levels between patients not requiring 14.1 g/dl (95% CI, 13.2-14.9; p < 0.001) and those needing transfusion 11.9 g/dl (95% CI, 10.9-12.9; p < 0.001) (p < 0.001). The per-patient total cost savings ranged from 2.10 to 191.27 dollars.

Conclusions: Our findings indicate that routine pretransfusion testing for all patients undergoing primary THA may be unnecessary. We recommend restricting pre-transfusion test orders to patients with preoperative haemoglobin levels below 12 g/dl specifically in the context of unilateral primary THA, always considering individual patient and surgical risk factors. This focused approach has the potential to yield substantial cost savings for healthcare systems and transfusion services by mitigating the unnecessary over-ordering of pre-transfusion tests associated with these surgical procedures.