Safe surgery: how accurate are we at predicting intra-operative blood loss?

Hdl Handle:
http://hdl.handle.net/10147/207252
Title:
Safe surgery: how accurate are we at predicting intra-operative blood loss?
Affiliation:
Surgical Registrar Medical Student Consultant Colorectal Surgeon, Department of, Surgery, Beaumont Hospital, Dublin, Ireland.
Citation:
J Eval Clin Pract. 2011 Dec 2. doi: 10.1111/j.1365-2753.2011.01779.x.
Journal:
Journal of evaluation in clinical practice
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207252
DOI:
10.1111/j.1365-2753.2011.01779.x
PubMed ID:
22133448
Abstract:
Introduction Preoperative estimation of intra-operative blood loss by both anaesthetist and operating surgeon is a criterion of the World Health Organization's surgical safety checklist. The checklist requires specific preoperative planning when anticipated blood loss is greater than 500 mL. The aim of this study was to assess the accuracy of surgeons and anaesthetists at predicting intra-operative blood loss. Methods A 6-week prospective study of intermediate and major operations in an academic medical centre was performed. An independent observer interviewed surgical and anaesthetic consultants and registrars, preoperatively asking each to predict expected blood loss in millilitre. Intra-operative blood loss was measured and compared with these predictions. Parameters including the use of anticoagulation and anti-platelet therapy as well as intra-operative hypothermia and hypotension were recorded. Results One hundred sixty-eight operations were included in the study, including 142 elective and 26 emergency operations. Blood loss was predicted to within 500 mL of measured blood loss in 89% of cases. Consultant surgeons tended to underestimate blood loss, doing so in 43% of all cases, while consultant anaesthetists were more likely to overestimate (60% of all operations). Twelve patients (7%) had underestimation of blood loss of more than 500 mL by both surgeon and anaesthetist. Thirty per cent (n = 6/20) of patients requiring transfusion of a blood product within 24 hours of surgery had blood loss underestimated by more than 500 mL by both surgeon and anaesthetist. There was no significant difference in prediction between patients on anti-platelet or anticoagulation therapy preoperatively and those not on the said therapies. Conclusion Predicted intra-operative blood loss was within 500 mL of measured blood loss in 89% of operations. In 30% of patients who ultimately receive a blood transfusion, both the surgeon and anaesthetist significantly underestimate the risk of blood loss by greater than 500 mL. Theatre staff must be aware that 1 in 14 patients undergoing intermediate or major surgery will have an unexpected blood loss exceeding 500 mL and so robust policies to identify and manage such circumstances should be in place to improve patient safety.
Language:
ENG
ISSN:
1365-2753 (Electronic); 1356-1294 (Linking)

Full metadata record

DC FieldValue Language
dc.date.accessioned2012-02-01T10:03:08Z-
dc.date.available2012-02-01T10:03:08Z-
dc.date.issued2012-02-01T10:03:08Z-
dc.identifier.citationJ Eval Clin Pract. 2011 Dec 2. doi: 10.1111/j.1365-2753.2011.01779.x.en_GB
dc.identifier.issn1365-2753 (Electronic)en_GB
dc.identifier.issn1356-1294 (Linking)en_GB
dc.identifier.pmid22133448en_GB
dc.identifier.doi10.1111/j.1365-2753.2011.01779.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/207252-
dc.description.abstractIntroduction Preoperative estimation of intra-operative blood loss by both anaesthetist and operating surgeon is a criterion of the World Health Organization's surgical safety checklist. The checklist requires specific preoperative planning when anticipated blood loss is greater than 500 mL. The aim of this study was to assess the accuracy of surgeons and anaesthetists at predicting intra-operative blood loss. Methods A 6-week prospective study of intermediate and major operations in an academic medical centre was performed. An independent observer interviewed surgical and anaesthetic consultants and registrars, preoperatively asking each to predict expected blood loss in millilitre. Intra-operative blood loss was measured and compared with these predictions. Parameters including the use of anticoagulation and anti-platelet therapy as well as intra-operative hypothermia and hypotension were recorded. Results One hundred sixty-eight operations were included in the study, including 142 elective and 26 emergency operations. Blood loss was predicted to within 500 mL of measured blood loss in 89% of cases. Consultant surgeons tended to underestimate blood loss, doing so in 43% of all cases, while consultant anaesthetists were more likely to overestimate (60% of all operations). Twelve patients (7%) had underestimation of blood loss of more than 500 mL by both surgeon and anaesthetist. Thirty per cent (n = 6/20) of patients requiring transfusion of a blood product within 24 hours of surgery had blood loss underestimated by more than 500 mL by both surgeon and anaesthetist. There was no significant difference in prediction between patients on anti-platelet or anticoagulation therapy preoperatively and those not on the said therapies. Conclusion Predicted intra-operative blood loss was within 500 mL of measured blood loss in 89% of operations. In 30% of patients who ultimately receive a blood transfusion, both the surgeon and anaesthetist significantly underestimate the risk of blood loss by greater than 500 mL. Theatre staff must be aware that 1 in 14 patients undergoing intermediate or major surgery will have an unexpected blood loss exceeding 500 mL and so robust policies to identify and manage such circumstances should be in place to improve patient safety.en_GB
dc.language.isoENGen_GB
dc.titleSafe surgery: how accurate are we at predicting intra-operative blood loss?en_GB
dc.contributor.departmentSurgical Registrar Medical Student Consultant Colorectal Surgeon, Department of, Surgery, Beaumont Hospital, Dublin, Ireland.en_GB
dc.identifier.journalJournal of evaluation in clinical practiceen_GB
dc.description.provinceLeinster-

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.