INTRODUCTION:Two valid group and saves are commonly required for patients undergoing laparoscopic appendicectomy and laparoscopic hernia repairs preoperatively; however, perioperative blood transfusions are seldom required. This is financially burdensome and frequently leads to delays in theatre lists. We performed a retrospective analysis to investigate blood transfusions performed perioperatively and within 28 days of these procedures.METHOD:We used our electronic records to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017 and March 2021. Patients of any age undergoing these operations were included. Patients requiring concomitant intra-abdominal surgery or who had incomplete medical records were excluded.RESULTS:A total of 1891 patients were included, of which 1462 (77.3%) had a laparoscopic appendicectomy versus 429 (22.7%) who had a laparoscopic hernia repair. In all, 3507 group and saves were taken costing £47,398.50. One patient (0.068%) required emergency blood transfusion (4 units of red cells) secondary to major haemorrhage.CONCLUSION:Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves.

Abstract Introduction Major haemorrhage is a rare complication of laparoscopic hernia repair and laparoscopic appendicectomy. It is common practice for patients undergoing these procedures to have 2 valid group and saves preoperatively, however perioperative blood transfusions for these patients is seldom required. Obtaining valid samples is not only financially burdensome but frequently leads to delays in theatre lists and patient care. Our unit therefore performed a retrospective cohort analysis to investigate blood transfusions performed perioperatively and within 28 days of laparoscopic appendicectomy and laparoscopic hernia repairs. Method We used our electronic records system to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017-March 2021. Patients of any age undergoing laparoscopic appendicectomy or laparoscopic hernia repair were included. Patients requiring concomitant intra-abdominal surgery or had incomplete medical records were excluded. Results 1893 patients were included in the study of which 1464(77.3%) had a laparoscopic appendicectomy vs 429(22.7%) laparoscopic hernia repair. In total 3511 group and saves were taken costing £47,398.50. Only 1 patient (0.068%) required an emergency blood transfusion (4 units of red cells) secondary to major haemorrhage and 2 patients (0.11%) required pre-operative transfusions for anaemia. Conclusion Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves. Considering our findings, the burden of cost, patient discomfort and theatre delays; we advocate a more nuanced approach to preoperative group and saves, reserving these for patients stratified as high risk.

Introduction: Chest pain is a common presentation to the Emergency Department (ED). Current international guidelines emphasise the importance of triage pathways involving patient-centric algorithms. In 2019, a front-door ED pathway (Figure 1) was created to direct low-risk chest pain towards ambulatory care. We aimed to characterise clinical outcomes with this pathway in a real-world UK ED cohort presenting with cardiac chest pain. Methods: The chest pain pathway stratified patients as low-, intermediate- and high-risk at presentation. Patients presenting to the ED at our institution in London, UK, were consecutively included in two groups: a pre-pathway group prior to implementation of the chest pain pathway and a post-pathway group following implementation. Baseline demographics were compared using Pearson’s χ 2 test for categorical variables and unpaired t-tests for continuous variables. Primary endpoints were 30-day readmissions, and all-cause mortality. Multiple logistic regression models were constructed to assess the impact of the pathway on the primary outcomes, adjusting for age, sex, risk category and HEART score. Results: Baseline demographics were similar between pre-pathway and post-pathway groups, except for presence of a smoking history ( p = 0.04). Smoking was therefore adjusted for in multivariable analyses. Approximately 10% (13/136) of post-pathway patients avoided hospital admission and were triaged towards ambulatory care. There was no significant difference in 30-day readmissions: 18/139 post-pathway vs 12/167 pre-pathway (OR 1.79, 95% CI 0.79 - 4.22, p = 0.17); or all-cause mortality: 2/167 pre-pathway vs 5/139 post-pathway (OR 2.96, 95% CI 0.49 - 25.68, p = 0.26). Conclusions: This novel chest pain pathway demonstrated a 10% reduction in hospital admissions without concurrent increases in 30-day readmissions or all-cause mortality. This is likely to reduce burdens on hospital resources and patient flow whilst maintaining safety.