Efficiency of Blood Utilization in Elective Surgical Patients in Addis Ababa, Ethiopia From November 2023 to April 2024. A Multi- Center Prospective Study

Abstract

<title>Abstract</title> <bold>Background: </bold>Blood transfusion is vital for managing patients with significant blood loss perioperatively. However, over-ordering of blood is prevalent, resulting in increased costs and resource wastage. Implementing various transfusion indices can help reduce unnecessary blood requests for elective surgical patients without compromising patient care. <bold>Objective:</bold> To assess the efficiency of blood utilization in elective surgeries and associated factors in Addis Ababa from November 1, 2023, to April 30, 2024. <bold>Methods:</bold> A multi-center cross-sectional analytical study was conducted over a period of six months from November 1, 2023, to April 30, 2024, at Tikur Anbessa Specialized Hospital (TASH), Menelik II Hospital (MH), Gandhi Memorial Hospital (GMH), and Lancet General Hospital (LGH). Hospitals were selected using simple random sampling. Using sequential sampling and a structured checklist, data were collected from all elective surgical patients during this period. Blood utilization was assessed using various parameters including cross-match to transfusion ratio (C/T), transfusion probability (%T), transfusion index (TI), and Maximum Surgical Blood Ordering Schedule (MSBOS) based on Mead's criterion for common surgical procedures. <bold>Results:</bold> During the six-month study, 574 elective surgeries were performed with blood requisitions for 469 cases (81.7%). Gynecology/Obstetrics had the highest requisitions (36.2%). Of the 927 units requested, 182 were used, resulting in a cross-match to transfusion ratio (C/T) of 4.53. Tikur Anbessa Specialized Hospital (TASH) showed relatively efficient blood utilization with a C/T ratio of 3.98, while Gandhi Memorial Hospital (GMH) had the highest transfusion probability at 32.6%. Neurosurgery had the highest transfusion probability at 65.3%, while Pediatrics and Orthopedics showed trends of over-ordering. Conclusion and Recommendations: Significant disparity between blood requested and utilized in elective surgeries leads to resource wastage and financial burden, necessitating revised blood ordering protocols. Implementing an updated MSBOS, utilizing C/T ratio and TI, and maintaining regular surveillance can optimize blood utilization and minimize over-ordering. <bold>Conclusion and Recommendations:</bold> Significant disparity between blood requested and utilized in elective surgeries leads to resource wastage and financial burden, necessitating revised blood ordering protocols. Implementing an updated MSBOS, utilizing C/T ratio and TI, and maintaining regular surveillance can optimize blood utilization and minimize over-ordering.