UPJ INSIGHT Cost Implications of Routine Preoperative Blood Typing and Crossmatching Prior to Robot-Assisted Laparoscopic Partial Nephrectomy

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UPJ INSIGHT Cost Implications of Routine Preoperative Blood Typing and Crossmatching Prior to Robot-Assisted Laparoscopic Partial Nephrectomy

By: Matthew M. Banti, MD; Atiyeh Samadi, MS; Mihaela E. Sardiu, PhD; Hadley Wyre, MD; Moben Mirza, MD; David Duchene, MD; Jeffrey M. Holzbeierlein, MD; Eugene K. Lee, MD | Posted on: 01 Oct 2022

Banti MM, Samadi A, Sardiu ME, et al. Cost implications of routine preoperative blood typing and crossmatching prior to robot-assisted laparoscopic partial nephrectomy. Urol Pract. 2022;9(5)357-363.

Study Need

Robot-assisted laparoscopic partial nephrectomy (RAPN) is associated with a lower transfusion risk than open partial nephrectomy. The extent of preoperative blood typing and crossmatching necessary for patients undergoing RAPN remains unknown. Routine preoperative testing is associated with significant financial cost. In this study, we aimed to define the perioperative transfusion rate in a high-volume RAPN practice, the factors that portend this outcome and the monetary resources involved.

What We Found

In 804 patients undergoing RAPN in a large academic practice, the observed rate of perioperative transfusion was 1.1%. No significant difference in tumor size, stage or location was observed between transfused and nontransfused patients. Multiple variables were shown to have predictive capacity using logistic regression (see Table). Routine blood typing and crossmatching cost $1,320 U.S. dollars per patient, with a scaled cost of $1,061,280 for the entire cohort.

Table. Logistic regression for predictive capacity

Variable	Odds Ratio (95% CI)	p Value
Estimated blood loss (ml)	1.01 (1.00–1.01)	0.001
Nephrometry score	1.47 (1.01–2.22)	0.05
Preop hemoglobin	0.51 (0.34–0.73)	0.0006
Preop hematocrit	0.77 (0.65–0.88)	0.0007

Limitations

The study was performed using retrospective data, which have inherent limitations. The vast majority of RAPN procedures were performed for stage 1 renal masses, and our conclusions may not be applicable to practices that utilize RAPN for patients with higher-complexity tumors. Hospital charges differ greatly between institutions, and cost savings may vary.

Implications for Patient Care

This study indicates that routine blood typing and crossmatching may not benefit most patients undergoing RAPN due to the low observed transfusion rate. Tumor complexity and the presence of preoperative anemia are factors that can be identified before surgery and should be used to guide the extent of preoperative testing.