Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Feb 27, 2024; 16(2): 419-428
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.419
Hemoglobin loss method calculates blood loss during pancreaticoduodenectomy and predicts bleeding-related risk factors
Chao Yu, Yi-Min Lin, Guo-Zhe Xian
Chao Yu, Yi-Min Lin, Guo-Zhe Xian, Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
Author contributions: Yu C designed the study, collected and analyzed data, and wrote the manuscript; Lin YM participated in the study’s conception and data collection; Xian GZ participated in study design and provided guidance; All authors read and approved the final version.
Supported by Shandong Provincial Natural Science Foundation General Project, No. ZR2020MH248.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Zhe Xian, MD, PhD, Chief Doctor, Professor, Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Weiqi Road, Huaiyin District, Jinan 250021, Shandong Province, China. xianguozhe@sdfmu.edu.cn
Received: September 24, 2023
Peer-review started: September 24, 2023
First decision: December 14, 2023
Revised: December 26, 2023
Accepted: January 19, 2024
Article in press: January 19, 2024
Published online: February 27, 2024
Abstract
BACKGROUND

The common clinical method to evaluate blood loss during pancreaticoduodenectomy (PD) is visual inspection, but most scholars believe that this method is extremely subjective and inaccurate. Currently, there is no accurate, objective method to evaluate the amount of blood loss in PD patients.

AIM

The hemoglobin (Hb) loss method was used to analyze the amount of blood loss during PD, which was compared with the blood loss estimated by traditional visual methods. The risk factors for bleeding were also predicted at the same time.

METHODS

We retrospectively analyzed the clinical data of 341 patients who underwent PD in Shandong Provincial Hospital from March 2017 to February 2019. According to different surgical methods, they were divided into an open PD (OPD) group and a laparoscopic PD (LPD) group. The differences and correlations between the intraoperative estimation of blood loss (IEBL) obtained by visual inspection and the intraoperative calculation of blood loss (ICBL) obtained using the Hb loss method were analyzed. ICBL, IEBL and perioperative calculation of blood loss (PCBL) were compared between the two groups, and single-factor regression analysis was performed.

RESULTS

There was no statistically significant difference in the preoperative general patient information between the two groups (P > 0.05). PD had an ICBL of 743.2 (393.0, 1173.1) mL and an IEBL of 100.0 (50.0, 300.0) mL (P < 0.001). There was also a certain correlation between the two (r = 0.312, P < 0.001). Single-factor analysis of ICBL showed that a history of diabetes [95% confidence interval (CI): 53.82-549.62; P = 0.017] was an independent risk factor for ICBL. In addition, the single-factor analysis of PCBL showed that body mass index (BMI) (95%CI: 0.62-76.75; P = 0.046) and preoperative total bilirubin > 200 μmol/L (95%CI: 7.09-644.26; P = 0.045) were independent risk factors for PCBL. The ICBLs of the LPD group and OPD group were 767.7 (435.4, 1249.0) mL and 663.8 (347.7, 1138.2) mL, respectively (P > 0.05). The IEBL of the LPD group 200.0 (50.0, 200.0) mL was slightly greater than that of the OPD group 100.0 (50.0, 300.0) mL (P > 0.05). PCBL was greater in the LPD group than the OPD group [1061.6 (612.3, 1632.3) mL vs 806.1 (375.9, 1347.6) mL] (P < 0.05).

CONCLUSION

The ICBL in patients who underwent PD was greater than the IEBL, but there is a certain correlation between the two. The Hb loss method can be used to evaluate intraoperative blood loss. A history of diabetes, preoperative bilirubin > 200 μmol/L and high BMI increase the patient's risk of bleeding.

Keywords: Pancreaticoduodenectomy, Hemoglobin loss, Calculated blood loss, Estimated blood loss

Core Tip: Visual inspection is commonly used clinically to assess blood loss during pancreaticoduodenectomy (PD), but most scholars believe that this method is extremely subjective and inaccurate. We applied the hemoglobin loss method to calculate the intraoperative and perioperative blood loss in patients with PD, and compared the blood loss between different surgical methods. Univariate regression analysis revealed that a history of diabetes, a preoperative bilirubin concentration > 200 μmol/L, and high body mass index increased bleeding risk.