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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2/2021

01-02-2021 | Heart Surgery | Review Article/Brief Review

Techniques for blood loss estimation in major non-cardiac surgery: a systematic review and meta-analysis

Authors: Alexandre Tran, MD, MSc, Jordan Heuser, MD, Timothy Ramsay, PhD, Daniel I. McIsaac, MD, MPH, Guillaume Martel, MD, MSc

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 2/2021

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Abstract

Purpose

Estimated blood loss (EBL) is an important tool in clinical decision-making and surgical outcomes research. It guides perioperative transfusion practice and serves as a key predictor of short-term perioperative risks and long-term oncologic outcomes. Despite its widespread clinical and research use, there is no gold standard for blood loss estimation. We sought to systematically review and compare techniques for intraoperative blood loss estimation in major non-cardiac surgery with the objective of informing clinical estimation and research standards.

Source

A structured search strategy was applied to Ovid Medline, Embase, and Cochrane Library databases from inception to March 2020, to identify studies comparing methods of intraoperative blood loss in adult patients undergoing major non-cardiac surgery. We summarized agreement between groups of pairwise comparisons as visual estimation vs formula estimation, visual estimation vs other, and formula estimation vs other. For each of these comparisons, we described tendencies for higher or lower EBL values, consistency of findings, pooled mean differences, standard deviations, and confidence intervals.

Principle findings

We included 26 studies involving 3,297 patients in this review. We found that visual estimation is the most frequently studied technique. In addition, visual techniques tended to provide lower EBL values than formula-based estimation or other techniques, though this effect was not statistically significant in pooled analyses likely due to sample size limitations. When accounting for the contextual mean blood loss, similar case-to-case variation exists for all estimation techniques.

Conclusions

We found that significant case-by-case variation exists for all methods of blood loss evaluation and that there is significant disagreement between techniques. Given the importance placed on EBL, particularly for perioperative prognostication models, clinicians should consider the universal adoption of a practical and reproducible method for blood loss evaluation.

Trial registration

PROSPERO (CRD42015029439); registered: 18 November 2015.PROSPERO (CRD42015029439); registered: 18 November 2015.
Appendix
Available only for authorised users
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Metadata
Title
Techniques for blood loss estimation in major non-cardiac surgery: a systematic review and meta-analysis
Authors
Alexandre Tran, MD, MSc
Jordan Heuser, MD
Timothy Ramsay, PhD
Daniel I. McIsaac, MD, MPH
Guillaume Martel, MD, MSc
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 2/2021
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-020-01857-4

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