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Cutaneous surgeons cannot predict blood-thinner status by intraoperative visual inspection
Stewart W West1, Clark C Otley, Tri H Nguyen
1Division of Dermatologic Surgery, Section of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Plastic and Reconstructive Surgery
|June 28, 2002
Summary
Cutaneous surgeons cannot reliably predict blood thinner use by observing intraoperative bleeding. This study found visual inspection of oozing is inaccurate for identifying patients on anticoagulants or antiplatelet agents.
Area of Science:
- Dermatology
- Surgical Oncology
- Pharmacology
Background:
- Surgeons often rely on visual cues during procedures.
- Intraoperative oozing is commonly used to infer blood thinner status.
- Objective evidence supporting this clinical belief is lacking.
Purpose of the Study:
- To evaluate the accuracy of visual inspection of intraoperative oozing in predicting blood thinner use.
- To determine if visual assessment correlates with anticoagulant or antiplatelet agent consumption.
- To provide objective data on a common surgical assumption.
Main Methods:
- Blinded physician evaluators assessed intraoperative oozing in 110 patients undergoing cutaneous excisional surgery.
- Evaluators rated oozing severity and judged the likelihood of blood thinner use.
- Patient-reported blood thinner use (aspirin, warfarin, vitamin E) served as the reference standard.
Main Results:
- Only 16.3% of patients actually taking blood thinners were correctly identified by visual assessment.
- A significant false-positive rate of 16.4% occurred, misidentifying non-users as users.
- Physician training level did not impact the accuracy of oozing assessment.
- Excessive oozing was observed in only 9.1% of patients, with 40% of those actually on blood thinners.
Conclusions:
- Visual inspection of intraoperative oozing is an unreliable method for determining a patient's blood thinner status.
- The commonly held belief among cutaneous surgeons is not supported by objective data.
- Blood thinner use does not appear to have a clinically significant adverse effect on oozing during cutaneous surgery.