Assessing the Accuracy of Visual Blood Loss Estimation in Open Reduction and Internal Fixation of the Femur in a Tertiary Hospital 2019-2022 A Retrospective Review

Abstract

Background. Accurate estimation of intraoperative blood loss is crucial for effective treatment, particularly in orthopedic procedures such as open reduction and internal fixation (ORIF) with intramedullary nails for femoral fractures. Traditional methods rely on visual estimation, which is subjective and prone to inaccuracy.
Objective. This study aims to evaluate the accuracy of visual blood loss estimation by comparing it with laboratory-based calculations derived from hematocrit and hemoglobin levels.
Methodology. This retrospective cohort study reviewed the medical records of 115 patients who underwent ORIF with intramedullary nails at a tertiary hospital from January 10, 2019, to December 28, 2022. Blood loss was assessed using two approaches: visual estimates recorded by operating room personnel and calculations based on preoperative and postoperative hematocrit and hemoglobin values. Paired t-tests were used to compare these measurements and differences between the requested and actual number of blood bags used.
Results. Significant differences were observed between preoperative and postoperative hemoglobin (p <0.00001)
and hematocrit levels (p <0.00001), indicating substantial blood loss. More blood bags were requested than used, with a mean difference of 0.95 (p <0.00001). Visual estimates of blood loss were lower than laboratory-based calculations, with a mean difference of 55 ml (p <0.00001) for hemoglobin-based EBL and 121 ml (p <0.00001) for hematocrit-based EBL.
Conclusion. Visual estimates of intraoperative blood loss differ significantly from laboratory-based methods, with surgeons underestimating blood loss, and overestimating transfusion needs. This study highlights the importance of adopting more precise, laboratory-based calculations for assessing blood loss in orthopedic surgeries.