Kavon Sharifi BS, Tanir Moreno MS, Samudani Dhanasekara PhD, Mia Ivos BA, Nicole Van Spronsen BS, Caroline Chung BS, Cyrus Caroom MD, Robyn Richmond MD, Ariel Santos MD
Background: Pelvic injuries after blunt trauma are often repaired with open reduction-internal fixation (ORIF), which can result in significant blood loss. We compared calculations of estimated perioperative blood loss (EPBL) against reported intraoperative blood loss (RIBL) by visual estimation to evaluate their accuracy during ORIF for pelvic fractures.
Methods: A retrospective observational study was conducted at a Level 1 trauma center. One hundred and forty-two patients requiring ORIF of acetabular and/or pelvic ring fracture between ages 18 to 89 years from March 1, 2017, to Feb. 28, 2019, were included. Estimated perioperative blood loss was calculated by the Gross Method. Statistical analyses were conducted using R statistical software. Medians and inter-quartile ranges were used to summarize variables. A two-sample Wilcoxon signed rank test was performed. The agreement and reproducibility of RIBL and EPBL were examined with concordance correlation coefficients (CCC) and Bland-Altman plots.
Results: Median RIBL was 450 mL [250, 800], while median EPBL was 2142 mL [1213, 3607]. The median difference was −1692 mL (p<0.001). The Bland-Altman plot showed consistent under-reporting in RIBL versus EPBL. A proportional bias (p < 0.001) indicated that the level of bias was not constant between levels of blood loss. The CCC between RIBL and EPBL was 0.076 [−0.016, 0.167]. Pearson’s Correlation Coefficient was 0.213 (p = 0.011). RIBL and EPBL had a weak positive correlation.
Discussion: Blood loss during ORIF calculated by EPBL was significantly higher than RIBL. Our results suggest that blood loss reporting may be inaccurate in ORIF of pelvic fractures. These findings necessitate formulation of an accurate method permitting proper blood loss reporting.
Keywords: postoperative blood loss, surgical blood loss, orthopedic surgery, estimation
Article citation: Sharifi, K, Moreno T. Dhanasekara S, Ivos M, Van Spronsen N, Chung C, Caroom C, Richmond R, Santos A. Accuracy of reporting estimated blood loss in open repair of pelvic and acetabular fractures. The Southwest Respiratory and Critical Care Chronicles 2021;9(41):1–7
From: The School of Medicine (KS, TM, MI, NVS, CC), Department of Surgery (SD, RR, AS), and Department of Orthopedics (CC), Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 7/5/2021
Accepted: 10/9/2021
Reviewer: Michael Phy DO
Conflicts of interest: none
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