Is group and saving before the modern transurethral resection of the prostate still necessary?

Abstract

A group and save (G&S) sample is routinely taken preoperatively for patients undergoing a transurethral resection of the prostate (TURP). This procedure has become a key endo-urological procedure; however, it can be associated with complications such as bleeding, potentially requiring blood transfusion. The aim of our study was to assess the need for preoperative G&S sampling in all patients undergoing TURP.

This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. Data was collected on G&S samples, blood products and post-operative complications such as clot retention or if patients required a blood transfusion.

All patients had G&S samples taken prior to their operation, of these, only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/dl(8). Six patients were also noted to develop clot retention following removal of catheter.

This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples prior to this procedure should be reviewed. This would give a financial benefit and relieve patients of an unnecessary test. We would recommend thorough optimisation of patients prior to surgery including review of anticoagulation and correction of any pre-operative anaemia.