Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Int J Colorectal Dis. 2021 Oct;36(10):2111-2117. doi: 10.1007/s00384-021-03925-7. Epub 2021 Apr 16.
Intraoperative estimated blood loss (EBL) is often reported in nearly all surgical papers; however, there is no consensus regarding its measurement. The aim of this study was to determine whether EBL (ml) is as reliable and reproducible in predicting complications as a simple binary grading of EBL.
All consecutive patients undergoing colectomies between January 2015 and December 2018 were included. EBL was assessed prospectively by the surgeon and anaesthesiologist in ml and with a binary scale: bleeding "as usual" versus "more than usual" by the surgeon. Differences between pre- and post-operative haemoglobin levels (ΔHb g/dl) were correlated to EBL. Blood loss impact on 30-day postoperative morbidity was analysed.
A total of 270 patients were included, with a mean age of 65 years (SD 17). Mean EBL documented by surgeons correlated to EBL by anaesthesiologists (79.5 ml, SD 99 vs. 84.5 ml, SD 118, ϱ = 0.926, p < 0.001). Surgeons and anaesthesiologists' EBL correlated also with ΔHb (ϱ = - 0.273, p = 0.01 and ϱ = - 0.344, p = 0.01, respectively). Patient with surgeon EBL ≥ 250 ml or graded as "more than usual" bleeding had significantly more severe complications (8% vs. 20%, p = 0.02 and 8% vs. 27%, p = 0.001, respectively).
Anaesthesiologist and surgeon's EBL correlated with ΔHb. Simple grading of blood loss as "usual" and "more than usual" predicted severe complications and higher mortality rates. This simple binary grading of blood loss in colon surgery could be an alternative to the estimation of blood loss in ml as it is easy to apply but needs to be validated externally.
术中估计失血量（EBL）经常在几乎所有外科文献中报告，但对于其测量方法尚无共识。本研究旨在确定 EBL（ml）是否像 EBL 的简单二进制分级一样可靠和可重复地预测并发症。
纳入 2015 年 1 月至 2018 年 12 月期间连续进行结肠切除术的所有患者。由外科医生和麻醉师以 ml 为单位和以二进制等级“如往常一样”和“多于往常”评估 EBL。术前和术后血红蛋白水平的差异（ΔHb g/dl）与 EBL 相关。分析失血对术后 30 天发病率的影响。
共纳入 270 例患者，平均年龄为 65 岁（SD 17）。外科医生记录的平均 EBL 与麻醉师记录的 EBL 相关（79.5 ml，SD 99 与 84.5 ml，SD 118，ρ=0.926，p<0.001）。外科医生和麻醉师的 EBL 也与ΔHb 相关（ρ=-0.273，p=0.01 和 ρ=-0.344，p=0.01）。外科医生 EBL≥250ml 或分级为“多于往常”出血的患者并发症明显更严重（8%比 20%，p=0.02 和 8%比 27%，p=0.001）。
麻醉师和外科医生的 EBL 与ΔHb 相关。简单的出血量分级为“通常”和“多于通常”预测严重并发症和更高的死亡率。这种在结肠手术中简单的血液流失二进制分级可以替代 ml 估计失血量，因为它易于应用，但需要外部验证。
