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Zhou J, Ye M, Jiang W, Zhu X. Quantification and influencing factors of perioperative hidden blood loss in patients undergoing laparoscopic ovarian cystectomy for benign ovarian tumours. J OBSTET GYNAECOL 2022; 42:3181-3186. [PMID: 35950341 DOI: 10.1080/01443615.2022.2109133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This retrospective, monocentric study quantified hidden blood loss (HBL) and investigated its influencing factors in benign ovarian tumour patients undergoing laparoscopic ovarian cystectomy. Data from 153 patients who underwent laparoscopic ovarian cystectomy were retrospectively reviewed. HBL was calculated using the formula derived from 'Nadler' and 'Cross'. Pearson correlation was carried out to measure the association between HBL and potential risk factors. The average HBL was 280.22 ± 168.42 mL, accounting for 84.13 ± 19.20% of total blood loss (TBL) (347.48 ± 179.05 mL), which was a change of almost fourteen-fold relative to median visible blood loss [20.00 mL (10.00 mL, 57.5 mL)]. Surgical time, number of excisional tumours and preoperative albumin values were risk factors for HBL. HBL represents a large proportion more than 80% of TBL in patients undergoing laparoscopic ovarian cystectomy. Collectively, HBL is helpful for estimating intraoperative blood loss and better guidance of haemostatic agents, which reduces postoperative complications and expedites postoperative recovery. Additionally, the estimation of HBL also contributes to the summary, reflection and improvement of surgical technique.IMPACT STATEMENTWhat is already known on this subject? There has been a growing number of surgical patients with perioperative anaemia, which appears to be inconsistent with measured levels of visible intraoperative blood loss and postoperative drainage. This substantial but easily underestimated blood loss is known as hidden blood loss. To date, no published articles have evaluated HBL and its related risk factors in benign ovarian tumour patients undergoing laparoscopic ovarian cystectomy.What the results of this study add? HBL accounts for a large amount of TBL in laparoscopy for benign ovarian tumours. Surgical time, number of excisional tumours and preoperative albumin values are risk factors for HBL.What the implications are of these findings for clinical practice and/or further research? The management of HBL is important for the administration of perioperative blooding loss. In this context, HBL can be applied to estimate intraoperative blood loss and be better guidance of haemostatic agents to reduce postoperative complications and hasten postoperative rehabilitation. Additionally, the estimation of HBL also contributes to the summary, reflection and improvement of surgical technique.
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Affiliation(s)
- Junhan Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Miaomiao Ye
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenxiao Jiang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Zhu W, Wei Z, Zhou T, Han C, Lv Z, Wang H, Feng B, Weng X. Bone Density May Be a Promising Predictor for Blood Loss during Total Hip Arthroplasty. J Clin Med 2022; 11:jcm11143951. [PMID: 35887715 PMCID: PMC9325145 DOI: 10.3390/jcm11143951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Total hip arthroplasty (THA), which is performed mostly in elderly individuals, can result in substantial blood loss and thereby imposes a significant physical burden and risk of blood transfusion. The femoral neck cut and reamed acetabulum are the main sites of intraoperative bleeding. Whether the bone density in that region can be used to predict the amount of blood loss in THA is unknown. Methods: We retrospectively analyzed adult patients undergoing primary THA in the Department of Orthopedics, Peking Union Medical College Hospital, from January 2018 to January 2020. All these patients underwent primary unilateral THA. Patients had their bone mineral density (BMD) recorded within the week before surgery and were stratified and analyzed for perioperative blood loss. Multivariable regressions were utilized to adjust for differences in demographics and comorbidities among groups. Results: A total of 176 patients were included in the study. Intraoperative blood loss was 280.1 ± 119.56 mL. Pearson correlation analysis showed a significant correlation between blood loss and preoperative bone density of both the femoral greater trochanter (R = 0.245, p = 0.001) and the Ward’s triangle (R = 0.181, p = 0.016). Stepwise multiple linear regression showed that preoperative bone density of the greater trochanter (p = 0.015, 95% CI: 0.004–0.049) and sex (p = 0.002) were independent risk factors for THA bleeding. The area under the receiver operating characteristic curve (AUROC) of the greater trochanter and Ward’s triangle was 0.593 (95% CI: 0.507–0.678, p = 0.035) and 0.603 (95% CI: 0.519–0.688, p = 0.018), respectively. The cutoff T value on the femoral greater trochanter for predicting higher bleeding was −1.75. Conclusions: In THA patients, preoperative bone density values of the femoral greater trochanter and sex could be promising independent predictors for bleeding during surgery. Osteoporosis and female patients might have lower blood loss in the THA operation.
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Affiliation(s)
- Wei Zhu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
| | - Zhanqi Wei
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
- School of Medicine, Tsinghua University, Haidian District, Beijing 100084, China
| | - Tianjun Zhou
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
| | - Chang Han
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
| | - Zehui Lv
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
| | - Han Wang
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
| | - Bin Feng
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
- Correspondence: (B.F.); (X.W.)
| | - Xisheng Weng
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China; (W.Z.); (Z.W.); (T.Z.); (C.H.); (Z.L.); (H.W.)
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China
- Correspondence: (B.F.); (X.W.)
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Hong WS, Zhang YX, Lin Q, Sun Y. Risk Factors Analysis and the Establishment of Nomogram Prediction Model of Hidden Blood Loss After Total Hip Arthroplasty for Femoral Neck Fracture in Elderly Women. Clin Interv Aging 2022; 17:707-715. [PMID: 35548382 PMCID: PMC9081002 DOI: 10.2147/cia.s363682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Wei-Shi Hong
- The Graduate School, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Ya-Xin Zhang
- The Graduate School, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Qun Lin
- The Graduate School, Dalian Medical University, Dalian, Liaoning, People’s Republic of China
| | - Yu Sun
- Department of Orthopedics, Northern Jiangsu People’s Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, People’s Republic of China
- Correspondence: Yu Sun, Email
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Ye M, Zhou J, Chen J, Yan L, Zhu X. Analysis of hidden blood loss and its influential factors in myomectomy. J Int Med Res 2020; 48:300060520920417. [PMID: 32397777 PMCID: PMC7223209 DOI: 10.1177/0300060520920417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study was performed to quantify hidden blood loss (HBL) and explore its influential factors in myomectomy. METHODS Two hundred nine patients who underwent myomectomy by laparotomy or laparoscopy from 1 January 2017 to 31 December 2018 were analyzed. Each patient's estimated blood volume and total blood loss (TBL) were calculated by the Nadler formula and Gross formula, respectively. The HBL was calculated by subtracting the visible blood loss (VBL) from the TBL. A multivariate linear stepwise analysis was applied to identify the influential factors of HBL in myomectomy. RESULTS The mean perioperative VBL and estimated TBL during myomectomy were 137.81 ±104.43 and 492.24 ± 225.00 mL, respectively. The mean HBL was 354.39 ± 177.69 mL, which accounted for 71.52% ± 15.75% of the TBL and was two to three times higher than the VBL. The duration of surgery, number of removed leiomyomas, and location of removed leiomyomas were independent risk factors for HBL in myomectomy. CONCLUSIONS HBL accounted for a significant percentage of TBL in myomectomy. A full understanding of the HBL in perioperative blood management may improve patients' postoperative rehabilitation.
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Affiliation(s)
- Miaomiao Ye
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junhan Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Chen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linzhi Yan
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Zhao Y, Hu J, Xiang J, Li W, Zhu X, Zhao M, Sun R, Hu Y, Zhang Q. Hidden blood loss and its risk factors in patients undergoing laparoscopy and laparotomy for cervical cancer management. Arch Gynecol Obstet 2019; 300:183-189. [PMID: 31006840 DOI: 10.1007/s00404-019-05162-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/12/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Laparoscopy and laparotomy are the two most common surgical options used to treat women with early-stage cervical cancer. This study aimed to examine the volume of hidden blood loss (HBL) between laparoscopy and laparotomy for cervical cancer and to identify its risk factors. METHODS Sixty-one patients treated with laparotomy and 50 patients treated with laparoscopy were enrolled in this study. Their medical data were collected to calculate the HBL according to the Nadler and Gross formula, and its risk factors were identified by multiple linear regression analysis. RESULTS The visible blood loss was 574.9 ± 271.6 mL in the laparotomy surgery; however, the HBL was 345.2 ± 258.6 mL, accounting for 38.3 ± 21.4% of true TBL. The visible blood loss in the laparoscopy group was 168.9 ± 121.9 mL, and the HBL was 185.1 ± 130.5 mL (52.3 ± 28.1% of true TBL). The HBL blood loss in laparotomy was more than laparoscopy (p < 0.01). Multiple linear regression analysis suggested that patient age (p = 0.012), surgical time (p = 0.037) and pathological tumour type (p = 0.014) were independent risk factors contributing to HBL in laparotomy. Meanwhile, the following risk factors were positively correlated with HBL in laparoscopy: pre-operative value of Hb (p = 0.002), pre-operative value of Hct (p = 0.003), surgical time (p = 0.035), pathological tumour type (p = 0.036) and diabetes mellitus (p = 0.022). Ten and eight patients had pre-operative anaemia in the laparotomy group and the laparoscopy group, respectively, and 54 and 29 post-operatively. CONCLUSIONS HBL is seriously underestimated, and accounts for a large percentage of total blood loss both in laparotomy and laparoscopy for cervical cancer. Additionally, age, pathological tumour type, pre-operative value of Hb and Hct, surgical time and diabetes mellitus have the potential to increase HBL. A correct understanding of HBL can ensure patient safety and improve post-operative rehabilitation.
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Affiliation(s)
- Yu Zhao
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Jianing Hu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Junmiao Xiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Wenju Li
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiujie Zhu
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Min Zhao
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Rongjiao Sun
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Yue Hu
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
| | - Qiong Zhang
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Tomimaru Y, Noguchi K, Morita S, Imamura H, Iwazawa T, Dono K. Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy? World J Surg 2018; 42:3685-3691. [PMID: 29728731 DOI: 10.1007/s00268-018-4655-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Less intraoperative blood loss is frequently reported as an advantage of laparoscopic hepatectomy (LH) over open hepatectomy (OH). However, the small work space during laparoscopic surgery could lead to insufficient blood suction from the abdominal cavity, with possible underestimation of intraoperative blood loss. This study compared estimated blood loss (E-BL) with intraoperatively counted blood loss (IC-BL) in patients undergoing LH. METHODS This study included 110 consecutive patients undergoing partial hepatectomy for solitary liver tumors (59 had OH and 51 had LH). IC-BL and E-BL were determined, and the difference between them was calculated based on the surgical approach. Factors affecting the difference were investigated. IC-BL was quantified from the suction fluid volume and weight of surgical gauzes used for blood and fluid collection. E-BL was calculated with the total blood volume and change in hematocrit. RESULTS Although there were no significant differences between IC-BL and E-BL in the OH group (292 ± 198 vs. 259 ± 167 mL, p = 0.1239), E-BL was significantly greater than IC-BL in the LH group (273 ± 166 vs. 128 ± 177 mL, p < 0.0001). Percentage of patients with E-BL > IC-BL in the LH group was significantly greater than in the OH group (86.3 vs. 42.4%, p < 0.0001). The surgical approach (OH/LH) was the only significant independent factor determining E-BL > IC-BL status. CONCLUSIONS E-BL was significantly greater than IC-BL only in patients undergoing LH, and the surgical approach (OH/LH) was the only factor affecting E-BL > IC-BL status. These results suggest that intraoperative blood loss may be underestimated during LH.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Kozo Noguchi
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Shunji Morita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Iwazawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
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