Measurement of Intraoperative Blood Loss in Pediatric Orthopaedic Patients: Evaluation of a New Method

Abstract

Introduction:Our goal was to validate a new method of intraoperative blood loss measurement in pediatric patients who undergo orthopaedic surgery.Methods:We prospectively collected surgical sponges from 55 patients who underwent pediatric posterior spinal fusion, single-event multilevel surgery, or hip reconstruction for measurement of intraoperative blood loss. We enrolled patients if expected estimated blood loss (EBL) was >200 mL. The methods used for blood loss assessment included the Triton sponge scanning system, visual method, gravimetric method, and measured assay (reference) method.Results:The Triton system calculation of cumulative EBL per patient against the reference method yielded a strong positive linear correlation (R2 = 0.88). A weaker correlation was noted between the gravimetric method and reference EBL (R2 = 0.49). The Triton system had a low bias and narrow limits of agreement relative to the reference method (49 mL; 95% CI, 30 to 68). The gravimetric method had a higher bias and wider limits of agreement (101 mL; 95% CI, 67 to 135). The comparison of visual total EBL against the reference method yielded a notable discrepancy.Discussion:Estimated blood loss measured using the Triton system correlated better with the reference method than with the gravimetric method. The visual estimation method was found to be inaccurate. Intraoperative use of the Triton system is convenient and precise for monitoring intraoperative blood loss.

Measurement of Intraoperative Blood Loss in Minimally Invasive Neurosurgery

“…Visual estimation is the prime method being used between the surgeon and the anaesthesiologist in the OR and it is highly dependent on blood loss found in suction canisters, surgical sponges, surgical drapes/gowns, and the operating room environment. Therefore, it is an inaccurate method of measurement [40], in which blood loss is underestimated [41] during times of high blood loss and overestimated when the blood loss volume is less [22]. This makes the patient susceptible to consequences that come with high blood loss, such as hypovolemic shock and the need for blood transfusions that in turn comes with their own set of consequences such as infections [42], hemolytic transfusion reactions, and in times of overestimations of blood loss, there is a risk of volume overload.…”

“…For surgeries that result in major blood loss, allogeneic blood transfusion (ABT) is commonly performed for hemodynamic management, hence making accurate determination of blood loss a necessity. There are several complications that come with ABT and doctors often tend to keep this procedure to a minimum, however in order to do so an increase in the methods for blood management [22,23]. The following methods are the readily available approaches that are commonly used by doctors today:…”

“…As mentioned earlier it is one of the direct methods used in calculating blood loss and is very common despite the fact that it is highly inaccurate. It is utilized by several surgeons and anaesthesiologists from assessing surgical sponges, suction canisters, and the operating room environment until they come to a decision [22].…”

“…Furthermore, although the spectrophotometric method is accepted as a standard reference method, there is a reported error range of up to 10%." [22].…”

Triton sponge and canister app for estimating surgical blood loss

“…After the FDA approval, several studies have been conducted involving major laparotomies, orthopedic surgeries (spine, arthroplasties), cesarean deliveries[12345] [Table 1]. Konig et al .…”