MP17-01 Is a Preoperative Type and Screen Required in Patients Undergoing Common Urological Procedures? A Cost-Benefit Analysis
Journal of Urology
INTRODUCTION AND OBJECTIVE:
Many institutions rely on historical data to guide preoperative type and screen (T/S) requirements. Our objective was to evaluate the cost-effectiveness of obtaining preoperative T/S for common urological procedures and determine patient and hospital factors associated with receiving blood transfusions.
Retrospective database analysis of the 2006-2015 National (Nationwide) Inpatient Sample (NIS) was performed to identify patients undergoing a variety of urological procedures where T/S is generally obtained. A total of 4,113,144 cases were identified. Transfusion rates were then determined from NIS data, and multivariate regression analyses was used to identify factors associated with transfusions. A cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.
On multivariate modeling, all Elixhauser comorbidities with the exception of obesity were significant associated with transfusion Some examples included chronic blood loss anemia (OR, 6.56, 95% CI, 6.24-6.89), coagulopathy (OR, 2.04; 95% CI, 1.96-2.12), diabetes (OR, 1.26; 95% CI, 1.19-1.33), liver disease (OR, 1.20; 95% CI, 1.13-1.29), pulmonary circulation disorders (OR, 1.38; 95% CI, 1.30-1.47), and metastatic cancer (OR, 2.69; 95% CI 2.54-2.85) (p <0.01 for all). The ICER of preoperative T/S for radical prostatectomy (transfusion rate=3.88%) and penile implants (transfusion rate=0.91%) were $1,607 and $7,709 per ERT prevented, respectively. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S.
Routine preoperative T/S for radical prostatectomy and penile implants does not represent a cost-effective practice for these surgeries using nationally representative data. A selective T/S policy for high risk patients may reduce costs.
Volin JH, Herndon PR, Spillinger AI, Karabon PR, Blumline JM, Tran DN, Fletcher CA, Hafron JS. MP17-01 IS A PREOPERATIVE TYPE AND SCREEN REQUIRED IN PATIENTS UNDERGOING COMMON UROLOGICAL PROCEDURES? A COST-BENEFIT ANALYSIS. Journal of Urology. 2021 Sep;206(Supplement 3). https://doi.org/10.1097/JU.0000000000002002.01. doi:10.1097/JU.0000000000002002.01.