ArticleCureus2025
Preoperative Group and Save Tests in Elective and Emergency Cholecystectomies: An Economic and Environmental Burden.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Background and objective Cholecystectomy is among the most frequently performed elective day-case surgeries in the UK, with a growing emphasis on same-day discharge. Although perioperative bleeding and the need for blood transfusion are uncommon with this procedure, routine group and save (G&S) testing is frequently performed for cholecystectomy, contributing to both a significant economic and environmental burden. This study aimed to assess the proportion of patients undergoing cholecystectomy who had preoperative G&S testing and to identify how many required a perioperative blood transfusion. Methods This study involved a retrospective analysis of 755 consecutive adult elective or emergency cholecystectomy procedures performed over a two-year period between August 2022 to 2024 in a North West England NHS trust. Patients were assessed from admission through to discharge. Data collected included American Society of Anesthesiologists (ASA) grade, surgical urgency, the number of preoperative G&S tests performed, and the incidence of perioperative red cell transfusion. Results Our cohort included 755 patients: 728 (96.4%) underwent total cholecystectomy, with 27 (3.6%) having associated cholecystectomy procedures. Seven hundred (92.7%) patients had an elective procedure, while 55 (7.3%) underwent an emergency cholecystectomy. The mean patient age was 49 years. Of the cohort, 159 patients (21%) were classified as ASA grade 1, 491 (65%) as ASA grade 2, and 105 (14%) as ASA grade 3. A total of 1,422 G&S samples were submitted for this cohort; 481 patients (64%) had two samples taken, while 92 patients (12%) had more than two G&S tests performed. Only one patient required a red cell transfusion, and two patients required a return to theatre due to anaemia secondary to haemorrhage. Conclusions Our findings suggest that routine preoperative G&S testing is not required in cholecystectomy, given the paucity of blood product transfusions. Unnecessary G&S testing costs our trust approximately £24,000 and consumes around 2,480 hours of laboratory time. This practice also imposes a considerable financial and environmental burden due to greenhouse gas emissions associated with the testing process. A more selective and stratified approach to G&S testing in cholecystectomy may prove beneficial in economic terms and work in synergy with the goal of improving sustainability in the NHS.
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