Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery.
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2013-11
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Abstract
Background
Estimates of blood loss in the operating room are typically performed as a visual assessment by providers, despite multiple studies showing this to be inaccurate. Use of a less subjective measurement of blood loss such as direct measurement of the hemoglobin (Hb) mass lost from the surgical field may better quantify surgical bleeding. The objective of this investigation was to compare anesthesiologist estimates of intraoperative blood loss with measured Hb loss.Study design and methods
Sixty patients undergoing posterior spine surgery were enrolled in a prospective, randomized trial comparing intraoperative blood loss using unipolar cautery alone or with use of a bipolar tissue sealant device. Hb concentration and fluid volume were measured from all surgical sponges, suction canisters, and the cell salvage device. Using the volume and concentration of Hb from each solution allowed calculation of Hb mass, which was converted into volume of blood lost and compared with estimates of blood loss documented by the anesthesia team. A single-sample t test of no difference was used to compare estimated with measured blood loss.Results
Mean estimated blood loss exceeded measured blood loss by 246 mL (860 mL vs. 614 mL, p < 0.0001).Conclusion
Estimated blood loss exceeded measured blood loss by 40% on average. The likely etiology of this discrepancy relates to the inability to visually determine Hb concentration of sanguineous solutions in suction canisters and surgical sponges. Ramifications of excessive bleeding estimates include unnecessary transfusion and overadministration of intravenous fluids, both of which may have deleterious effects.Type
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Guinn, Nicole R, Bob W Broomer, William White, William Richardson and Steven E Hill (2013). Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery. Transfusion, 53(11). pp. 2790–2794. 10.1111/trf.12119 Retrieved from https://hdl.handle.net/10161/31393.
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Nicole Renee Guinn
Originally from Anchorage, Alaska, Dr. Guinn attended Mount Sinai School of Medicine in New York, NY, where she graduated with AOA honors. She then completed her anesthesiology residency and fellowship in cardiothoracic anesthesia at Duke University Medical Center, staying on as faculty after completing her training. Dr. Guinn served as the Medical Director of the Center for Blood Conservation at Duke University Medical Center from 2013-2022, working with patients who decline transfusion to receive safe care and improved outcomes, and developing an institutional Preoperative Anemia Clinic to diagnose and treat anemia in operative patients at risk for transfusion. She is known nationally for her expertise in management of patients “When Blood is Not an Option” and for preoperative optimization of anemia in surgical patients and is the current Chair for the ASA Committee on Patient Blood Management. Dr. Guinn is also involved with the American Board of Anesthesiology, serving as an OSCE Committee member and APPLIED examiner for board certification in the anesthesiology. She is the current Interim Division Chief of neuro-anesthesiology, otolaryngology and offsite anesthesia at Duke University.
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