Cross-Matching in Spinal Surgery: An Audit of Compliance at the National Spinal Injuries Unit (NSIU)

Abstract

Aims
Excessive preoperative cross-matching can waste resources and shorten blood product shelf-life. The purpose of this study was to evaluate compliance with the Maximum Surgical Blood Order Schedule (MSBOS) in spinal surgery at NSIU and to quantify the impact of deviations on red cell utilisation and cost, before and after implementation of a revised departmental guideline.

Methods
A two-cycle, closed-loop audit at NSIU comparing how practice before and after a revised, spine-specific departmental transfusion guideline aligned with Maximum Surgical Blood Order Schedules was performed. Outcomes included MSBOS compliance, Red Cell Concentrate (RCC) utilisation, and estimated cost impact; two-sided tests were used.

Results
Comparing October 2024 (63 surgeries) and May 2025 (50 surgeries), MSBOS compliance improved (33/63 [52%] to 36/50 [72%]; p=0.03), over-crossmatching decreased (27/63 [43%] to 6/50 [12%]; p<0.001), and estimated overspend fell (€19,662 to €6,780). Neither cycle required intra-operative ordering beyond preoperative plans.

Discussion
Implementation of a revised, spine-focused transfusion guideline improved compliance and reduced unnecessary cross-matching at NSIU without compromising peri-operative safety.