Comparison Of Blood Loss Measuring Methods In Hepatectomy And Risk Factor Analysis

Aim: To investigate the accuracy of three kinds of methods in measuring ofintraoperative blood loss and analyze the risk factors contributing to theintraoperative bleeding during hepatectomy. Methods: In a retrospectivestudy of clinical data of44hepatectomies from2013September to2013November, we compared the amount of intraoperative blood loss by threemethods (accurate weighing methods. anesthesiologists estimatiom.haemoglobin correction method by measuring preoperative and postopertiveHaemoglobin concentraion) and analyzed the factors influencing theintraoperative bleeding. Results: we compared the three approaches in44patients and found that there were statistically significant difference（z=9.14，p=0.01）.The estimated blood loss by weighing method(986±642ml) wassignificantly(P=0.005) higher than that of anesthesiologists estimated blood loss(693±587ml) and statistically(P=0.013) more than that of haemoglobincorrection mehtod (868±1064ml). We defined the blood loss≥800ml asexcessive bleeding. We analyzed using non-parametric test the clinical data ofblood loss which were measured by accurate weighing methods（age, sex, bodyweight, Child-Pugh scoring, BCLC staging, liver cirrhosis (+/-),tumor size）between minor bleeding (<800ml) and excessive bleeding (>800ml),in which22cases (50%) were excessive bleeding and another22cases(50%)were minorbleeding. We found that Child-Pugh scoring influencing intraoperative bleeding(Z=-2.449, P=0.013). Different surgeon teams have different amount ofintraoperative blood loss during hepatectomy. We analyzed the amount ofblood loss of in four surgeon teams. Pairwise comparison between each teamswas accessed by Games-Howell method and found that surgeon teams1vs.2,1vs.4,2vs.3,3vs.4were statistically significant （p=0.01,0.01,0.01,0.01）respectively. Binary logistic regression was accessed between minor andexcessive bleeding and found that abnormality of liver parenchyma (with orwithout cirrhosis)[p=0.048,OR=5.78(95%CI1.013-33.07)], and size of tumor[p=0.03,OR=6.67(95%CI0.206-36.87)] were independently associated with theintra-operartive bleeding. The more sever of liver cirrhosis, the moreintra-operative blood loss; the bigger the tumor size, the more intra-operativeblood loss. Conclusion: Intra-operative blood loss is strongly associated withthe meticulous surgical technique and surgeon’s experience. Preoperativeassessment of tumor’s size and severity of liver cirrhosis, and well preoperativemanagement are important procedure to prevent hypovolemic shock duringoperation.