Quantification of Intraoperative Blood Loss Following Surgical Repair of Peritrochanteric Femur Fractures

Context: There are a variety of techniques to determine blood loss during orthopedic surgeries, yet there is no current accepted standard. One measurement technique is to rely on physician estimations. However, this leaves room for error and inconsistency. Aims: We highlight the error of physician estimated blood loss (EBL) values and demonstrate a consistent way to calculate blood loss for isolated peritrochanteric femur fractures at our institution. Settings and Designs: This single-site retrospective chart review includes 223 patients ≥18 years old who presented with an isolated peritrochanteric femur fracture and subsequently received surgical intervention. We recorded physician (surgeon and anesthesia) EBLs. Subjects and Methods: We used the Nadler formula and the hemoglobin balance method formula to calculate blood loss. Statistical Analysis Used: Wilcoxon signed-rank tests compared reliability between EBL of physicians with calculated EBL. An intraclass correlation coefficient (ICC) <0.5 means poor agreement between the two compared parties. Results: A significant difference was demonstrated between EBL reported by orthopedic surgeons (mean = 300 ml standard deviation [SD] = 290 ml) and calculated blood loss values (mean = 990 ml SD =590 ml) with an ICC value of −0.16 (95% confidence interval (CI) = −0.29, −0.024) ( P < 0.0001). A significant difference also exists between EBL reported by Anesthesiologists (mean = 350 ml, SD = 300 ml) and calculated blood loss values (mean = 1000 ml, SD = 580 ml) with an ICC of −0.05 (95% CI −0.19, 0.09) ( P < 0.0001). Conclusions: A significant difference exists between EBLs by both the orthopedic surgeon and the anesthesia physician when compared to the calculated blood loss methods. Additionally, both physician EBLs underestimate blood loss when compared to the calculated blood loss method.