Examining the Utility and Cost of Routine Type and Screen Prior to Minimally Invasive Hysterectomy

BACKGROUND AND OBJECTIVES: Pre-operative type and screen (T&S) is typically obtained if a patient is expected to require a blood transfusion; however, in cases of minimal blood loss, routine T&S may be unnecessary. The objective of our study was to examine the utility and cost of routine pre-operative T&S prior to minimally invasive hysterectomies (MIH). METHODS: We performed a retrospective chart review of all MIH from January 1, 2018 to December 31, 2019. Patient demographics and surgical parameters were abstracted. The proportion of MIH with a preoperative T&S was compared to the rate of peri-operative blood transfusion. Statistical tests were used where appropriate. Logistic regression was used to examine the relationship between pre-operative hemoglobin (Hgb) and peri-operative transfusion. RESULTS: Patients (n = 307) with a mean age of 54 (standard deviation = 12.6) underwent MIH. T&S was ordered in 42.7% of cases, with 2.9% requiring a blood transfusion. Two-thirds of women receiving a transfusion had a history of anemia (p = .004). Women with a pre-operative Hgb < 10.6 gm/dL (n = 30) had a 27% probability of a transfusion, while those with a pre-operative Hgb > 10.6 gm/dL (n = 264) had a 99% probability of no transfusion. A T&S costs ∼$190 at our institution; if routine T&S was eliminated prior to MIH, cost savings is projected to be ∼$11,590 annually. CONCLUSION: Approximately 42.7% of MIH had T&S ordered, but only 2.9% received transfusions. Most patients who required a transfusion had a history of anemia. Significant cost savings could be incurred if routine T&S was eliminated prior to MIH.