Wareham Carly M, De La Cruz Ku Gabriel, Karamchandani Manish M, Chatterjee Abhishek, Persing Sarah M, Homsy Christopher
From the Department of Surgery, Tufts Medical Center, Boston, MA.
Universidad Científica del Sur, Lima, Peru.
Plast Reconstr Surg Glob Open. 2025 Aug 12;13(8):e6988. doi: 10.1097/GOX.0000000000006988. eCollection 2025 Aug.
Estimated blood loss (EBL), based on surgeons' visual estimation of blood loss, guides patient care but is often inaccurate. Calculated blood loss (CBL), a measurement of the volume of blood lost, is a more accurate substitute. Our aim was to assess the differences between EBL and CBL in plastic surgery.
A retrospective analysis was conducted on 35 patients who underwent deep inferior epigastric perforator flaps, oncoplastic surgery, breast reductions, or mastectomies in 1 hospital over 18 months.
The surgeons underestimated EBL (median EBL 250 versus CBL 388 cc, < 0.001). EBL and CBL from surgeon 2, a senior surgeon, were not statistically different compared with those of surgeon 1 (250 versus 250 cc, = 0.958; 363 versus 501 cc, = 0.143), but tended to have less delta EBL-CBL (113 versus 273 cc, = 0.066). Both breast reductions/mastectomies and deep inferior epigastric perforators had higher CBL (200 versus 360 cc, < 0.001; 300 versus 748 cc, = 0.015), but less delta EBL-CBL (116 versus 438 cc, = 0.054). There was a strong negative relationship between EBL and postoperative hemoglobin, and a moderate relationship between CBL and delta EBL-CBL with case duration, intraoperative fluids, and urine output.
The surgeons underestimate blood loss, but the senior surgeon tended to do so to a lesser extent. Complex and longer procedures tended to have a greater discrepancy between EBL and CBL. CBL should be considered as a reliable alternative to EBL.
基于外科医生对失血量的视觉估计得出的估计失血量（EBL）指导着患者护理，但往往不准确。计算失血量（CBL），即对失血量的测量，是一种更准确的替代方法。我们的目的是评估整形外科中EBL和CBL之间的差异。
对18个月内在1家医院接受腹壁下深动脉穿支皮瓣、肿瘤整形手术、乳房缩小术或乳房切除术的35例患者进行回顾性分析。
外科医生低估了EBL（EBL中位数为250 cc，而CBL为388 cc，<0.001）。与外科医生1相比，资深外科医生2的EBL和CBL在统计学上没有差异（250 cc对250 cc，=0.958；363 cc对501 cc，=0.143），但EBL-CBL差值往往较小（113 cc对273 cc，=0.066）。乳房缩小术/乳房切除术和腹壁下深动脉穿支皮瓣的CBL均较高（200 cc对360 cc，<0.001；300 cc对748 cc，=0.0一五），但EBL-CBL差值较小（116 cc对438 cc，=0.054）。EBL与术后血红蛋白之间存在强烈的负相关关系，CBL与EBL-CBL差值与手术时间、术中补液量和尿量之间存在中度相关关系。
外科医生低估了失血量，但资深外科医生低估的程度往往较小。复杂且耗时较长的手术，EBL和CBL之间的差异往往更大。应将CBL视为EBL的可靠替代方法。
