Minimising costs in spinal surgery: is group & save testing justified in lumbar decompression surgery?

BACKGROUND: Lumbar microdiscectomy and laminectomy are two of the most common neurosurgical procedures performed worldwide. Current practice still sees pre-operative group and save testing prior to this surgery. The aim of this study was to determine the need for pre-operative group and save and post-operative blood checks.

METHODS: Patient archives were reviewed to identify those undergoing primary elective lumbar decompression surgery at the Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK. Hematology results before and after surgery, whether group and save was carried out, and blood transfusion requirements, if any, were collected.

RESULTS: A total of 200 patients in total were included. Ninety-one percent of microdiscectomy patients and 95% of laminectomy patients underwent group and save testing prior to surgery. No patients received a transfusion as a result of their procedure. The mean hemoglobin drop after surgery was 11 g/L for the microdiscectomy group and 17 g/L for the laminectomy group.

CONCLUSIONS: Our findings strongly suggest that pre-operative group and save is unnecessary in lumbar microdiscectomy and laminectomy. As such, we support the abandonment of routine pre-operative group and save and post-operative blood checks, with significant cost saving effects. However, O negative blood should always be available in case of major peri-operative bleeding.