Techniques for blood loss estimation in major non-cardiac surgery: a systematic review and meta-analysis
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Techniques for blood loss estimation in major non-cardiac surgery: a systematic review and meta-analysis Les techniques d’estimation des pertes sanguines lors de chirurgie non cardiaque majeure : une revue syste´matique et me´ta-analyse Alexandre Tran, MD, MSc . Jordan Heuser, MD . Timothy Ramsay, PhD . Daniel M. McIsaac, MD, MPH . Guillaume Martel, MD, MSc Received: 26 March 2020 / Revised: 25 August 2020 / Accepted: 28 August 2020 Ó Canadian Anesthesiologists’ Society 2020
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
This article is accompanied by an editorial. Please see Can J Anesth 2021; this issue.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01857-4) contains supplementary material, which is available to authorized users. A. Tran, MD, MSc J. Heuser, MD Department of Surgery, University of Ottawa, Ottawa, ON, Canada T. Ramsay, PhD Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada D. M. McIsaac, MD, MPH Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada G. Martel, MD, MSc (&) Department of Surgery, University of Ottawa, Ottawa, ON, Canada e-mail: [email protected] Ottawa Hospital Research Institute, The Ottawa Hospital – General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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
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