Prospective validation of a blood ordering protocol for elective spine arthrodesis and its impact on cost reduction

Muhammad Waqas, Aga Khan University
Muhammad Shahzad Shamim, Agha Khan University
Badar Uddin Ujjan, Aga Khan University
Dr Saqib Kamran Bakhshi, Aga Khan University



On the basis of an institutional audit, the authors published an individual patient-based protocol for preoperative arrangement of blood products in patients undergoing elective spine arthrodesis. The present study was conducted for the prospective validation of the proposed protocol in reducing cross match to transfusion ratio, and its implications on overall cost.


This cross-sectional study was conducted over 1 year (2012). All adult patients who underwent elective spinal arthrodesis were included and prospectively observed. The actual transfusion index was calculated for individual patients with the formula C1/T, where C1 is the number of units of packed RBCs cross matched and T is the number of actual transfusions. C1/T was then compared with a theoretical transfusion index C2/T for the same group of patients, C2 being the number derived from calculating the number of units of packed RBCs that would have been ordered for individual patient according to the protocol. The cost difference between C1/T and C2/T was analyzed.


A total of 125 patients were included. A total of 435 units of packed RBCs were ordered (C1), out of which only 108 units were transfused (T), yielding a C1/T of 4.02. The C2 for the same group of patients was 188 units of packed RBCs and the C2/T was thus calculated to be 1.74. Implementation of the protocol would reduce per patient cost from Pakistani Rupees (PKR) 6676.8 ± 4125.8 to 4700.8 ± 1712.86, with a P < 0.001 and an overall reduction of 30%.


Cross match to transfusion ratio and blood ordering related cost are both significantly reduced with the application of institutional cross-match protocol.