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Validity of Estimates of Intraoperative Blood Loss in Pediatric Spinal Deformity Surgery
James F Mooney1, William R Barfield2
1Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB 708, Charleston, SC 29425, USA.
Insights
Surgeons and anesthesiologists significantly differ in estimating blood loss during pediatric spinal surgery. Surgeons
Area of Science:
- Pediatric Orthopedic Surgery
- Spinal Deformity Correction
- Anesthesiology
Background:
- Intraoperative blood loss is a significant concern in pediatric spinal deformity surgery.
- Minimizing blood loss is crucial for reducing transfusion needs.
- Accuracy of current blood loss measurement methods is questionable.
Purpose of the Study:
- To compare estimated blood loss (EBL) between anesthesia providers and surgeons in pediatric spinal deformity surgery.
- To assess the agreement between two common methods of EBL estimation.
Main Methods:
- Institutional review board-approved study.
- Compared EBL from anesthesia records with surgeon's EBL calculated using Cell-Saver data.
- Data collected from 51 pediatric spinal deformity patients.
Main Results:
- Mean EBL (surgeon) was 795.84 mL vs. 669.30 mL (anesthesia).
- Mean % estimated blood volume loss (%EBVL) was 22.9% (surgeon) vs. 19.8% (anesthesia).
- Statistical significance (p = .010) found between both EBL and %EBVL measurements.
Conclusions:
- Significant differences exist in EBL estimates between surgeons and anesthesiologists.
- Surgeons' EBL estimates were consistently higher than anesthesiologists'.
- Discrepancies highlight the need for consistent reporting of blood loss data in research.
Introduction:
Intraoperative blood loss is a significant concern in pediatric spinal deformity surgery, and numerous reports exist in the literature regarding this issue. Multiple interventions are used to minimize intraoperative blood loss and subsequent need for blood product replacement during and after these procedures. However, a basic question remains regarding the overall accuracy of intraoperative blood loss measurements used to generate these studies.
Materials And Methods:
We performed an institutional review board-approved study that compared estimated blood loss (EBL) by the anesthesia provider and surgeon after the completion of surgery for pediatric spinal deformity by a single surgeon. We used the estimate by the anesthesia provider that was to be part of the anesthesia record. The surgeon's estimate was generated based on a formula employing the volume of blood products processed by a Cell-Saver device and available for reinfusion.
Results:
We collected data from 51 patients. The mean EBL (surgeon) was 795.84 mL and mean EBL (anesthesia) was 669.30 mL. The mean percent estimated blood volume loss (%EBVL) (surgeon) was 22.9% and mean %EBVL (anesthesia) was 19.8%. Student t-test analysis demonstrated statistical significance between both sets of values (EBL, p = .010; %EBVL, p = .010).
Conclusions:
There was a statistically significant difference in EBL values for this patient sample between the anesthesiologist and orthopedic surgeon; the surgeon's estimates were significantly higher. This difference may be important in interpreting existing studies regarding interventions used to minimize surgical blood loss. In addition, this lack of agreement highlights the need for authors to be more accurate and consistent regarding the source of blood loss data in future clinical studies.
