TY - JOUR
T1 - Surgeon-Estimated Blood Loss Is Discordant With Calculated Blood Loss in Acetabular and Pelvic Fracture Surgery
AU - Lindsay, Sarah E.
AU - McKibben, Natasha
AU - Yang, Qian
AU - Zusman, Natalie Lacey
AU - Friess, Darin M.
AU - Working, Zachary Mark
N1 - Publisher Copyright:
© 2023 Wolters Kluwer Health, Inc.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Objectives:To compare blood loss as estimated by surgeon-estimated blood loss (EBL), the Gross formula, and the HB equation in open pelvic and acetabular surgery.Design:Retrospective cohort study.Setting:Single Level I academic trauma center.Patients:We included 710 patients 18-89 years of age who underwent acetabular or pelvic surgery between 2008 and 2018 for the management of fracture.Intervention:Surgical treatment for the management of acetabular or pelvic fracture and blood transfusion when deemed clinically appropriate in the perioperative setting.Main Outcome Measures:Surgeon EBL and calculated blood loss (using the Gross formula, a Gross formula derivative, and the HB equation with both Moore and Nadler blood volume estimations).Results:One hundred ninety-two patients (27%) received intraoperative blood transfusions. Surgeon EBL significantly differed from all formulas except the Gross/Nadler and the modified Gross/Nadler calculations. Gross and HB calculation methods yielded similar results in the overall cohort but yielded significantly different results in the subgroup analysis. Use of a corrective transfusion factor mildly improved correlation of the Gross equation with EBL. At high levels of blood loss, surgeon EBL predictions became more discordant with calculated blood loss values. When assessing only patients who did not receive transfusions, concordance improved.Conclusion:Blood loss in pelvic and acetabular surgery is challenging to quantify, and this study demonstrates discordance between formula predictions and surgeon-estimated blood loss. At higher levels of blood loss, this discrepancy worsens. This exploratory study highlights the need for the development of improved methods of quantifying blood loss in orthopaedic trauma surgery.
AB - Objectives:To compare blood loss as estimated by surgeon-estimated blood loss (EBL), the Gross formula, and the HB equation in open pelvic and acetabular surgery.Design:Retrospective cohort study.Setting:Single Level I academic trauma center.Patients:We included 710 patients 18-89 years of age who underwent acetabular or pelvic surgery between 2008 and 2018 for the management of fracture.Intervention:Surgical treatment for the management of acetabular or pelvic fracture and blood transfusion when deemed clinically appropriate in the perioperative setting.Main Outcome Measures:Surgeon EBL and calculated blood loss (using the Gross formula, a Gross formula derivative, and the HB equation with both Moore and Nadler blood volume estimations).Results:One hundred ninety-two patients (27%) received intraoperative blood transfusions. Surgeon EBL significantly differed from all formulas except the Gross/Nadler and the modified Gross/Nadler calculations. Gross and HB calculation methods yielded similar results in the overall cohort but yielded significantly different results in the subgroup analysis. Use of a corrective transfusion factor mildly improved correlation of the Gross equation with EBL. At high levels of blood loss, surgeon EBL predictions became more discordant with calculated blood loss values. When assessing only patients who did not receive transfusions, concordance improved.Conclusion:Blood loss in pelvic and acetabular surgery is challenging to quantify, and this study demonstrates discordance between formula predictions and surgeon-estimated blood loss. At higher levels of blood loss, this discrepancy worsens. This exploratory study highlights the need for the development of improved methods of quantifying blood loss in orthopaedic trauma surgery.
KW - acetabular fracture
KW - calculated blood loss
KW - estimated blood loss
KW - pelvic fracture
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U2 - 10.1097/BOT.0000000000002551
DO - 10.1097/BOT.0000000000002551
M3 - Article
C2 - 36729005
AN - SCOPUS:85153411785
SN - 0890-5339
VL - 37
SP - E188-E193
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 5
ER -