Accurate Measurement of Intraoperative Blood Loss Improves Prediction of Postoperative Hemoglobin Levels

Thurer, Robert L.; Castro, Jose Muniz; Javidroozi, Mazyar; Burton, Kimberly A.; Bernal, Nicole P.

doi:10.4172/2155-6148.1000743

Cited by 8 publications

(7 citation statements)

References 20 publications

(22 reference statements)

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“…By entering the preoperative Hb-level, the blood loss can then be calculated. In the studies analyzed, high degrees of correlation with the reference blood volumes were found [ 22 , 24 , 26 – 28 , 39 , 67 , 68 , 70 , 83 ] (For a detailed description of the various studies, please refer to supplement 6).…”

Section: Resultsmentioning

confidence: 99%

“…The risk of bias due to confounders was increased in the majority of the studies. The selection of participants in study groups showed an increased risk of bias in four studies [19][20][21][22] and an unclear risk of bias in two studies [23,24]. The documentation and endpoint assessment were adequately described in most of the studies.…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

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Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Gerdessen

Meybohm

Choorapoikayil

et al. 2020

J Clin Monit Comput

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Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.

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Section: Resultsmentioning

confidence: 99%

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Gerdessen

Meybohm

Choorapoikayil

et al. 2020

J Clin Monit Comput

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show abstract

“…6 Histogram of the differences The histogram shows frequency of differences between visually estimated (V-EBL) for canister and reference blood loss we were able to identify an advantage in measurement of blood volume in sponges by technically supported methods such as colorimetric blood loss estimation. Experimental studies of this system have also been published for canisters [12][13][14][15][16][17][18]. With colorimetric blood loss estimation, blood volume in sponges or canisters can be measured in real time.…”

Section: Discussionmentioning

confidence: 99%

The visually estimated blood volume in scaled canisters based on a simulation study

et al. 2021

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Background The most common technique used worldwide to quantify blood loss during an operation is the visual assessment by the attending intervention team. In every operating room you will find scaled suction canisters that collect fluids from the surgical field. This scaling is commonly used by clinicians for visual assessment of intraoperative blood loss. While many studies have been conducted to quantify and improve the inaccuracy of the visual estimation method, research has focused on the estimation of blood volume in surgical drapes. The question whether and how scaling of canisters correlates with actual blood loss and how accurately clinicians estimate blood loss in scaled canisters has not been the focus of research to date. Methods A simulation study with four “bleeding” scenarios was conducted using expired whole blood donations. After diluting the blood donations with full electrolyte solution, the sample blood loss volume (SBL) was transferred into suction canisters. The study participants then had to estimate the blood loss in all four scenarios. The difference to the reference blood loss (RBL) per scenario was analyzed. Results Fifty-three anesthetists participated in the study. The median estimated blood loss was 500 ml (IQR 300/1150) compared to the RBL median of 281.5 ml (IQR 210.0/1022.0). Overestimations up to 1233 ml were detected. Underestimations were also observed in the range of 138 ml. The visual estimate for canisters correlated moderately with RBL (Spearman’s rho: 0.818; p < 0.001). Results from univariate nonparametric confirmation statistics regarding visual estimation of canisters show that the deviation of the visual estimate of blood loss is significant (z = − 10.95, p < 0.001, n = 220). Participants’ experience level had no significant influence on VEBL (p = 0.402). Conclusion The discrepancies between the visual estimate of canisters and the actual blood loss are enormous despite the given scales. Therefore, we do not recommend estimating the blood loss visually in scaled suction canisters. Colorimetric blood loss estimation could be a more accurate option.

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“…Additionally, it provides real-time information on blood loss and potentially improves the treatment of bleeding patients and targeted haemotherapy. So far, colorimetric blood loss estimation is only capable of analysing white sponges [25][26][27][28][29].…”

Section: Plos Onementioning

confidence: 99%

Do we visually estimate intra-operative blood loss better with white or green sponges and is the deviation from the real blood loss clinically acceptable? Results from a simulated scenario study

et al. 2020

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Background The intraoperative blood loss is estimated daily in the operating room and is mainly done by visual techniques. Due to local standards, the surgical sponge colours can vary (e.g. white in US, green in Germany). The influence of sponge colour on accuracy of estimation has not been in the focus of research yet. Material and methods A blood loss simulation study containing four “bleeding” scenarios each per sponge colour were created by using expired whole blood donation samples. The blood donations were applied to white and green surgical sponges after dilution with full electrolyte solution. Study participants had to estimate the absorbed blood loss in sponges in all scenarios. The difference to the reference blood loss was analysed. Multivariate linear regression analysis was performed to investigate other influence factors such as staff experience and sponge colour. Results A total of 53 anaesthesists participated in the study. Visual estimation correlated moderately with reference blood loss in white (Spearman's rho: 0.521; p = 3.748*10 −16 ) and green sponges (Spearman's rho: 0.452; p = 4.683*10 −12 ). The median visually estimated blood loss was higher in white sponges (250ml IRQ 150–412.5ml) than in green sponges (150ml IQR 100-300ml), compared to reference blood loss (103ml IQR 86–162.8). For both colour types of sponges, major under- and overestimation was observed. The multivariate statistics demonstrates that fabric colours have a significant influence on estimation (p = 3.04*10 −10 ), as well as clinician’s qualification level (p = 2.20*10 −10 , p = 1.54*10 −08 ) and amount of RBL to be estimated (p < 2*10 −16 ). Conclusion The deviation of correct blood loss estimation was smaller with white surgical sponges compared to green sponges. In general, deviations were so severe for both types of sponges, that it appears to be advisable to refrain from visually estimating blood loss whenever possible and instead to use other techniques such as e.g. colorimetric estimation.

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Accurate Measurement of Intraoperative Blood Loss Improves Prediction of Postoperative Hemoglobin Levels

Cited by 8 publications

References 20 publications

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

The visually estimated blood volume in scaled canisters based on a simulation study

Do we visually estimate intra-operative blood loss better with white or green sponges and is the deviation from the real blood loss clinically acceptable? Results from a simulated scenario study

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