Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery

Nicole R. Guinn, Bob W. Broomer, William White, William Richardson, Steven E. Hill

Research output: Contribution to journalArticle

31 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2790-2794
Number of pages5
JournalTransfusion
Volume53
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Hemoglobins
Spine
Surgical Sponges
Suction
Hemorrhage
Cautery
Equipment and Supplies
Operating Rooms
Blood Volume
Anesthesia

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery. / Guinn, Nicole R.; Broomer, Bob W.; White, William; Richardson, William; Hill, Steven E.

In: Transfusion, Vol. 53, No. 11, 11.2013, p. 2790-2794.

Research output: Contribution to journalArticle

Guinn, Nicole R. ; Broomer, Bob W. ; White, William ; Richardson, William ; Hill, Steven E. / Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery. In: Transfusion. 2013 ; Vol. 53, No. 11. pp. 2790-2794.
@article{c940236cb49047429d4b679211c7dac9,
title = "Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery",
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.",
author = "Guinn, {Nicole R.} and Broomer, {Bob W.} and William White and William Richardson and Hill, {Steven E.}",
year = "2013",
month = "11",
doi = "10.1111/trf.12119",
language = "English (US)",
volume = "53",
pages = "2790--2794",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery

AU - Guinn, Nicole R.

AU - Broomer, Bob W.

AU - White, William

AU - Richardson, William

AU - Hill, Steven E.

PY - 2013/11

Y1 - 2013/11

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84887816146&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887816146&partnerID=8YFLogxK

U2 - 10.1111/trf.12119

DO - 10.1111/trf.12119

M3 - Article

C2 - 23438094

AN - SCOPUS:84887816146

VL - 53

SP - 2790

EP - 2794

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 11

ER -