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Estimated Blood Loss During Vaginal Hysterectomy and Adnexal Surgery Described With an Intraoperative Pictographic Tool

Nelson, Nancy C., MD*; Ostby, Stuart A., MD; Weaver, Amy L., MS; McGree, Michaela E., BS; Gebhart, John B., MD§; Bakkum-Gamez, Jamie N., MD§

Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 - Volume 24 - Issue 5 - p 347–351
doi: 10.1097/SPV.0000000000000470
Original Articles

Objective We describe a novel way to calculate estimated blood loss (EBL) using an intraoperative pictographic tool in gynecologic surgery.

Methods A pictographic tool to estimate sponge saturation was developed to calculate EBL during surgery. A prospective cohort of women 18 years or older undergoing benign vaginal hysterectomy with planned adnexal surgery at Mayo Clinic were consented for use of the pictographic tool. Demographic, preoperative, intraoperative, and postoperative data were abstracted. Estimated blood loss was compared among surgeons, anesthesia providers, and the pictographic tool and then correlated with change in hemoglobin.

Results Eighty-one patients met inclusion with mean age of 45.3 ± 8.7 years. Successful vaginal hysterectomy was achieved in all patients with successful completion of planned adnexectomy in 69 (85.2%). Mean EBL among surgeons, anesthesia providers, and pictographic estimates, respectively, was as follows: 199.4 ± 81.9 mL, 195.5 ± 152.2 mL, and 288.5 ± 186.6 mL, with concordance correlation coefficients for surgeons and anesthesia providers versus pictographic tool of 0.40 (95% confidence interval, 0.29–0.51) and 0.68 (95% confidence interval, 0.57–0.79), respectively. The mean postoperative change in hemoglobin was −1.8 g/dL; there were no postoperative transfusions. Change in hemoglobin was more correlated with blood loss estimates from surgeons (r = −0.31, P = 0.008) and anesthesia providers (r = −0.37, P = 0.003) than the pictographic tool (r = −0.19, P = 0.11).

Conclusions Use of a pictographic tool to objectively estimate blood loss demonstrated significant overestimations compared with both anesthesia providers’ and surgeons’ estimates because the pictographic tool was less correlated with postoperative change in hemoglobin than anesthesia provider and surgeon estimates.

From the *Mayo School of Graduate Medical Education and

Mayo Clinic School of Medicine,

Division of Biomedical Statistics and Informatics, and

§Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.

Correspondence: Jamie N. Bakkum-Gamez, MD, Eisenberg Lobby 71, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail:

The authors have declared they have no conflicts of interest.

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