NUREDDİN YÜZKAT, CELALEDDİN SOYALP, NURÇİN GÜLHAŞ

Comparison of the Error Rates of an Anesthesiologist and Surgeon in Estimating Perioperative Blood Loss in Major Orthopedic Surgeries: Clinical Observational Study

Objective: Since the anesthesiologist and surgeon have different observation angles in the intra- operative period, their predictions based on clinical observation vary greatly. Whether these predictions accurately reflect actual blood loss is still a matter of debate. The aim of this study was to compare the clinical observations of anesthesiologists and surgeons on perioperative blood loss and transfusion requirements with laboratory results. Methods: Sixty patients who were scheduled for major orthopedic surgery were included in the study. Same anesthesiologist and the same surgeon were asked to estimate the amount of blood loss , and whether blood transfusion was needed during the perioperative period. The amount of blood loss was calculated synchronously using the perioperative hemoglobin value and the total blood volume. The blood loss estimates of the anesthesiologist and the surgeon were compared, with blood loss calculated in the laboratory. Results: The anesthesiologist’s and the surgeon’s estimates of perioperative mean blood loss volume were found to be lower than the blood volume calculated in the laboratory (p=0.01). When the estimated blood loss was less than 600 mL, it was considered as overestimation, and when it was more than 600 mL then it was interpreted as 20% underestimation (p=0.01). According to our findings, the rate of error in the perioperative blood loss estimates was 28.72%. When the blood loss was more than 1000 mL, the error rate of predictions was 34.03%; when it was less than 1000 mL, the error rate of predictions was 25.18%. Conclusion: We believe that when blood loss is more than 1000 mL in major orthopedic surgeries, the error in the estimation is increased, the amount of blood loss is difficult to predict, and the anesthesiologist makes a better prediction than the surgeon.

Major Ortopedik Cerrahilerde Anesteziyolog ve Cerrahın Kan Kaybı Tahminlerindeki Hata Paylarının Karşılaştırılması: Klinik Gözlemsel Çalışma

Amaç: Anesteziyolog ve cerrah intraoperatif dönemde farklı gözlem açılarına sahip olduğundan, klinik gözleme dayalı tahminleri büyük değişkenlikler içermektedir. Bu tahminlerin gerçek kan kaybını ne kadar doğru yansıtabildiği halen tartışılan bir konudur. Bu çalışmada, anesteziyolog ve cerrahın, perioperatif kan kaybı ve transfüzyon gerekliliği hakkındaki klinik gözlemlerinin, labora- tuvar sonuçları ile karşılaştırılması amaçlandı. Yöntem: Major ortopedik cerrahi planlanan, 60 olgu çalışmaya dahil edildi. Aynı anestezi uzma- nından ve aynı cerrahtan kan kaybı miktarını ve kan transfüzyonuna gerek duyulup duyulmadığı- nı perioperatif dönemde tahmin etmeleri istendi. Perioperatif hemoglobin değerleri ve total kan hacmi kullanılarak kan kaybı eşzamanlı hesaplandı. Anesteziyolog ve cerrahın tahminleri ile labo- ratuvara göre hesaplanan kan kaybı istatistiksel olarak karşılaştırıldı. Bulgular: Anesteziyolog ve cerrahın perioperatif ortalama kan kaybı volümü tahminleri, laboratuvar sonuçlarına göre hesaplanan kan kaybı volümünden daha düşük bulundu (p=0.01). Hesaplanan kan kaybı 600 mL’den az olduğunda tahminlerin daha yüksek, 600 mL’den yüksek olduğunda ise tahmin- lerin %20 daha düşük olduğu saptandı (p=0.01). Bulgularımıza göre, perioperatif kan kaybı tahmi- ninde yanılma oranı %28.72 olarak saptandı. Kan kaybı 1000 mL’den fazla olduğunda tahminde yanılma oranı %34.03; 1000 mL’den az olduğunda yanılma oranı %25.18 olarak bulundu. Sonuç: Major ortopedik cerrahilerde kan kaybı 1000 ml’den fazla olduğunda tahminde yanılma oranının arttığı, kan kaybını tahmin etmenin güçleştiği ve anesteziyoloğun cerrahtan daha iyi tahminde bulunduğu düşüncesindeyiz.

PDF

___

Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology: McGraw-Hill New York; 2013.

Adkins AR, Lee D, Woody DJ, White W. Accuracy of blood loss estimations among anesthesia providers. AANA J. 2014;82:300-6.

Al Kadri HM, Al Anazi BK, Tamim HM. Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study. Archives of Gynecology Obstetrics. 2011;283:1207-13. https://doi.org/10.1007/s00404-010-1522-1

Pranal M, Guttmann A, Ouchchane L, et al. Do estima- tes of blood loss differ between student midwives and midwives? A multicenter cross-sectional study. Midwifery. 2018;59:17-22. https://doi.org/10.1016/j.midw.2017.12.017

Park JH, Rasouli MR, Mortazavi SJ, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. JBJS. 2013;95:1777- 83. https://doi.org/10.2106/JBJS.L.01335

Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elec- tive knee and hip arthroplasty in Europe. Transfusion. 2003;43:459-69. https://doi.org/10.1046/j.1537-2995.2003.00348.x

Iijima T, Brandstrup B, Rodhe P, Andrijauskas A, Svensen CH. The maintenance and monitoring of perioperative blood volume. Perioperative Medicine. 2013;2:9. https://doi.org/10.1186/2047-0525-2-9

Nadler SB, Hidalgo JU, Bloch T. Prediction of blood volume in normal human adults. Surgery. 1962;51:224- 32.

Goh M, Kleer CG, Kielczewski P, Wojno KJ, Kim K, Oesterling JE. Autologous blood donation prior to ana- tomical radical retropublic prostatectomy: is it neces- sary? Urology. 1997;49:569-74. https://doi.org/10.1016/S0090-4295(96)00548-1

Dildy GA, Paine AR, George NC, Velasco C. Estimating blood loss: can teaching significantly improve visual estimation? Obstetrics Gynecology. 2004;104:601-6. https://doi.org /10.1097/01.AOG.0000137873. 07820.34

Glance LG, Dick AW, Mukamel DB, et al. Association between intraoperative blood transfusion and morta- lity and morbidity in patients undergoing noncardiac surgery. Anesthesiology. 2011;114:283-92. https://doi.org/10.1097/ALN.0b013e3182054d06

Guinn NR, Broomer BW, White W, Richardson W, Hill SE. Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery. Transfusion. 2013;53:2790-4. https://doi.org/10.1111/trf.12119

McCullough TC, Roth JV, Ginsberg PC, Harkaway RC. Estimated blood loss underestimates calculated blood loss during radical retropubic prostatectomy. Urologia Internationalis. 2004;72:13-6. https://doi.org/10.1159/000075266

Chang IH, Byun SS, Hong SK, Lee SE. Assessing the body mass index of patients might help to predict blood loss during radical retropubic prostatectomy in Korean men. BJU International. 2007;99:570-4. https://doi.org/10.1111/j.1464-410X.2006.06637.x

Brecher M, Monk T, Goodnough L. A standardized met- hod for calculating blood loss. Transfusion. 1997;37:1070-4. https://doi.org/10.1046/j.1537-2995.1997.371098016448.x

Meiser A, Casagranda O, Skipka G, Laubenthal H. Quantification of blood loss. How precise is visual esti- mation and what does its accuracy depend on? Der Anaesthesist. 2001;50:13-20. https://doi.org/10.1007/s001010050957

Schorn MN. Measurement of blood loss: review of the literature. The Journal of Midwifery Women’s Health. 2010;55:20-7. https://doi.org/10.1016/j.jmwh.2009.02.014

Sukprasert M, Choktanasiri W, Ayudhya N, Promsonthi P, O-Prasertsawat P. Increase accuracy of visual estima- tion of blood loss from education programme. J Med Assoc Thai. 2006;89:S54-9.

Zuckerwise L, Raab C, Buhimschi C, Pettker C, Lipkind H. 541: Estimating blood loss: can an easily accessible visual aid significantly improve visual estimation? American Journal of Obstetrics Gynecology. 2013;208:232-3. https://doi.org/10.1016/j.ajog.2012.10.707

Razvi K, Chua S, Arulkumaran S, Ratnam S. A compari- son between visual estimation and laboratory detenni- nation of blood loss during the third stage of labour. Australian New Zealand Journal of Obstetrics Gynaecology. 1996;36:152-4. https://doi.org/10.1111/j.1479-828X.1996.tb03273.x

Wu W-C, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative out- comes in older patients undergoing noncardiac sur- gery. JAMA. 2007;297:2481-8. https://doi.org/10.1001/jama.297.22.2481

Sehat K, Evans R, Newman J. How much blood is really lost in total knee arthroplasty?: correct blood loss management should take hidden loss into account. The Knee. 2000;7:151-5. https://doi.org/10.1016/S0968-0160(00)00047-8

Turan A, Tükenmez B, Karamanlıoğlu B, Süt N, Pamukçu Z. A model in intraoperative bleeding evaluation; diffe- rence of anesthetist-surgeon and experience. Turkiye Klinikleri Journal of Anesthesiology Reanimation. 2004;2:12-6.

Shabaninejad H, Ghadimi N, Sayehmiri K, Hosseinifard H, Azarfarin R, Gorji HA. Comparison of invasive and noninvasive blood hemoglobin measurement in the operating room: a systematic review and meta-analysis. Journal of Anesthesia. 2019;33:441-53. https://doi.org/10.1007/s00540-019-02629-1