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Br J Hosp Med (Lond). 2014 Dec;75(12):708-10. doi: 10.12968/hmed.2014.75.12.708.

Is a preoperative group and save necessary for enhanced recovery joint replacement patients?

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FY1 in the Department of Ear, Nose and Throat Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B18 7QH.



To consider the financial benefit to the authors' trust of omitting a preoperative group and save in enhanced recovery arthroplasty patients, and to estimate the scope for national savings. Patient safety was considered to determine acceptability for routine practice.


A total of 121 patients receiving a total knee replacement or total hip replacement on the authors' enhanced recovery protocol were selected. Pre- and postoperative haemoglobin levels were obtained. The transfusion team were contacted when the postoperative haemoglobin level was ≤8 g/dl to determine whether blood products had been issued. Costs for group and save were obtained from the pathology department.


Mean postoperative reduction in haemoglobin level was 2.6 g/dl (P≤0.001) and 2.1 g/dl (P≤0.001) for total hip replacement and total knee replacement respectively. No patients were transfused. One group and save costs £12.00, and omission of this test in these patients would have saved £1452.00. Potentially, £1 605 408 could have been saved in the 133 784 patients undergoing NHS arthroplasty in 2012. Group and save omission would not affect management of intraoperative haemorrhage where O negative blood would be available. If a transfusion is required postoperatively it would take 100 minutes to issue crossmatched blood - a time delay unlikely to compromise patient safety.


These results suggest that a preoperative group and save could be omitted in arthroplasty patients on this enhanced recovery programme to prevent needless expenditure, but more long-term follow up is required to ensure patients are not put at risk.

[Indexed for MEDLINE]

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