The provision of packed red blood cells (PRBCs) prior to certain planned intracranial surgeries has been common practice in neurosurgery. The question, however, arises how often these blood products are actually being transfused to the patient. In view of the shortage of this important resource and in the context of refining the standard operating procedures (SOP), it is necessary to determine the actual needs.

PRBCs were orded preoperatively according to a departmental SOP. For the present study, 612 patients older than 12 years, who underwent elective intracranial surgery (over a period of 3 years) were analyzed retrospectively. Emergencies, burrhole procedures and pediatric interventions were excluded. When processing the data, the type of surgery, duration of surgery, age and gender of the patients, experience of the surgeon and postoperative complications were evaluated.

In the total cohort of 612 patients, 269 were men and 343 were women. Mean age was 58.2 years (range: 12- 90 years. Gender and age distribution were similar in those patients who had provision of PRCBs preoperatively and patients who did not. According to the SOP preoperative PRCBs, were orded mainly for elective vascular surgery and large tumors, mainly meningiomas. In 31/612 (5.1%) patients an intracranial blood transfusion was necessary (17 patients with preoperative provision of PRBCs (54.8%), 14 without (45.2%)). According to the existing SOP, PRBCs were orded in 33/612 patients. Of those 33 patients, 17 had an intraoperative transfusion (51.5%), while 16 did not receive blood products (48.5%). In the subgroup of 579/612 (94.6%) patients who had no preoperative provision of PRCBs 14 patients had an intraoperative transfusion (2.4%), while 565 did not (97.6%). While unplanned transfusions were necessary only in a minority of those patients who had no preoperative provision of PRBCs, only about half of the patients with preoperative provision of PRBCs needed intraoperative blood transfusions. According to subitem analysis modifications of the current SOP are made to further increase specificity.

Our current study shows that the need of PRCBs for elective intracranial neurosurgical procedures is low. Preoperative provision of PRCBs is useful for certain entities according to defined SOPs. Such SOPs need to be adjusted concerning quality control algorithms.