Abstract
BACKGROUND: Routine preoperative group-and-save (G+S) testing remains common before laparoscopic appendectomy in UK hospitals, despite limited evidence of its necessity. This study evaluated the clinical need and cost-effectiveness of routine G+S sampling in patients undergoing laparoscopic appendectomy at a single centre over 10 years. METHODS: We conducted a retrospective cohort study at Homerton University Hospital, London, UK, including all patients who underwent emergency or elective laparoscopic appendectomy between October 2014 and October 2024. Electronic records were used to identify patients and any perioperative transfusions. For transfused patients, operative and medical records were reviewed to determine the indication and timing of transfusion (surgical bleeding vs. other causes, intraoperative vs. postoperative). Demographic and clinical data were extracted by two independent reviewers and anonymized. We compared our transfusion rate to those reported in six published studies using two-proportion z-tests (significance p<0.05). A cost analysis estimated the financial impact of routine G+S, using the National Health Service (NHS) cost of £15-£21 per test. RESULTS: Among 1,733 patients (mean age 51 years; 925 males, 808 females), five (0.29%) received blood transfusions. None occurred intraoperatively. Only two patients (0.12%) required red cell transfusions due to postoperative surgical bleeding (one following perforated appendicitis and one unexplained hemorrhage). The other three transfusions were for non-surgical causes: one patient with sickle cell disease (red cells), one with postoperative anemia (fresh frozen plasma), and one with sepsis-related coagulopathy (platelets). Our overall red cell transfusion rate (0.17%) did not differ significantly from published rates (range 0-0.46%; all p>0.05). There were no deaths. Routine G+S testing for all 1,733 patients would have cost approximately £26,000-£36,500 over the 10 years (≈£15-£21 per test); with only two clinically relevant surgical transfusions, the cost per such case would exceed £13,000. CONCLUSION: Routine preoperative G+S testing before laparoscopic appendectomy provides minimal clinical benefit in low-risk patients and represents unnecessary resource use. Our 10-year data show an extremely low transfusion rate, with most transfusions driven by patients' underlying conditions rather than operative bleeding. These findings support a selective, risk-based approach to G+S: reserve testing for patients with significant comorbidities or anticipated complex surgery while omitting routine G+S in low-risk cases. Such a strategy would maintain patient safety but reduce laboratory workload and costs.