Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Abstract Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.

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

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-020-01857-4 ◽

2020 ◽

Author(s):

Alexandre Tran ◽

Jordan Heuser ◽

Timothy Ramsay ◽

Daniel I. McIsaac ◽

Guillaume Martel

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Blood Loss ◽

Meta Analysis ◽

Loss Estimation ◽

Blood Loss Estimation

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

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-020-01886-z ◽

2020 ◽

Author(s):

Alexandre Tran ◽

Jordan Heuser ◽

Timothy Ramsay ◽

Daniel I. McIsaac ◽

Guillaume Martel

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Blood Loss ◽

Meta Analysis ◽

Loss Estimation ◽

Blood Loss Estimation

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Open versus arthroscopic ankle arthrodesis: A systemic review and meta-analysis

10.21203/rs.3.rs-17549/v1 ◽

2020 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

SOUNDARYA PANNEERSELVAM ◽

Huajun Wang ◽

Huige Hou ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Cohort Studies ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

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Open versus arthroscopic ankle arthrodesis: A systematic review and meta-analysis

10.21203/rs.3.rs-17549/v2 ◽

2020 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

Soundarya Panneerselvam ◽

Huajun Wang ◽

Huige Hou ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Cohort Studies ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden . Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

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A systematic review and meta-analysis of endoscopic versus open treatment of craniosynostosis. Part 1: the sagittal suture

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.4.peds17729 ◽

2018 ◽

Vol 22 (4) ◽

pp. 352-360 ◽

Cited By ~ 12

Author(s):

Han Yan ◽

Taylor J. Abel ◽

Naif M. Alotaibi ◽

Melanie Anderson ◽

Toba N. Niazi ◽

...

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Blood Loss ◽

Open Surgery ◽

Meta Analysis ◽

Operating Time ◽

Transfusion Rate ◽

Endoscopic Procedures ◽

Estimated Blood Loss ◽

Cosmetic Outcomes

OBJECTIVEIn this systematic review and meta-analysis the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of sagittal craniosynostosis, focusing on the outcomes of blood loss, transfusion rate, length of stay, operating time, complication rate, cost, and cosmetic outcome.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Effect estimates between groups were calculated as standardized mean differences with 95% CIs. Random and fixed effects models were used to estimate the overall effect.RESULTSOf 316 screened records, 10 met the inclusion criteria, of which 3 were included in the meta-analysis. These studies reported on 303 patients treated endoscopically and 385 patients treated with open surgery. Endoscopic surgery was associated with lower estimated blood loss (p < 0.001), shorter length of stay (p < 0.001), and shorter operating time (p < 0.001). From the literature review of the 10 studies, transfusion rates for endoscopic procedures were consistently lower, with significant differences in 4 of 6 studies; the cost was lower, with differences ranging from $11,603 to $31,744 in 3 of 3 studies; and the cosmetic outcomes were equivocal (p > 0.05) in 3 of 3 studies. Finally, endoscopic techniques demonstrated complication rates similar to or lower than those of open surgery in 8 of 8 studies.CONCLUSIONSEndoscopic procedures are associated with lower estimated blood loss, operating time, and days in hospital. Future long-term prospective registries may establish advantages with respect to complications and cost, with equivalent cosmetic outcomes. Larger studies evaluating patient- or parent-reported satisfaction and optimal timing of intervention as well as heterogeneity in outcomes are indicated.

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Impact of Prostate Size on the Outcomes of Radical Prostatectomy: A Systematic Review and Meta-Analysis

Cancers ◽

10.3390/cancers13236130 ◽

2021 ◽

Vol 13 (23) ◽

pp. 6130

Author(s):

Omar Fahmy ◽

Nabil A. Alhakamy ◽

Osama A. A. Ahmed ◽

Mohd Ghani Khairul-Asri

Keyword(s):

Systematic Review ◽

Radical Prostatectomy ◽

Blood Loss ◽

Meta Analysis ◽

Oncological Outcome ◽

Estimated Blood Loss ◽

Prostate Size ◽

Oncological Results ◽

Complications Rate ◽

The Impact

Background: The impact of prostate size on the radical prostatectomy outcome is not clear. Several published reports have shown conflicting results. Objectives: To investigate the effect of prostate size on the surgical, functional and oncological results of radical prostatectomy. Methods: A systematic review and meta-analysis were carried out in accordance with the PRISMA criteria. Finally, we investigated the research that reported on the impact of prostate size on radical prostatectomy outcome. The Review Manager (RevMan) software version 5.4 was utilized for statistical analysis. Results: Eighteen studies including 12,242 patients were included. Estimated blood loss was significantly less with smaller prostates (Z = 3.01; p = 0.003). The complications rate was 17% with larger prostates, compared to 10% for smaller prostates (Z = 5.73; p < 0.00001). Seventy-three percent of patients with a smaller prostate were continent within one month, compared to 64% with a larger prostate (Z = 1.59; p = 0.11). The rate of positive surgical margins was significantly higher with smaller prostates (20.2% vs. 17.8%). (Z = 2.52; p = 0.01). The incidence of biochemical recurrence was higher with smaller prostates (7.8% vs. 4.9%) (Z = 1.87; p = 0.06). Conclusion: Larger prostate size is associated with more blood loss and a higher rate of complications. However, the oncological outcome is better, compared to that in patients with smaller prostates. The impact of the size on the functional outcome is not clear.

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Antifibrinolytics reduces blood loss in thoracic surgery: a systematic review and meta‐analysis

ANZ Journal of Surgery ◽

10.1111/ans.16909 ◽

2021 ◽

Author(s):

Lowell Leow ◽

Josiah Ng ◽

Hai Dong Luo ◽

Andrew M. T. L. Choong ◽

Harish Mithiran ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Thoracic Surgery ◽

Meta Analysis

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Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Global Spine Journal ◽

10.1177/21925682211016426 ◽

2021 ◽

pp. 219256822110164

Author(s):

Elsayed Said ◽

Mohamed E. Abdel-Wanis ◽

Mohamed Ameen ◽

Ali A. Sayed ◽

Khaled H. Mosallam ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Interbody Fusion ◽

Revision Rate ◽

Meta Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Operation Time ◽

Controlled Trials ◽

Lumbar Interbody Fusion ◽

Randomized Controlled

Study Design: Systematic review and meta-analysis. Objectives: Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. Methods: Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. Results: We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. Conclusions: This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.

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