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Objective <p>To evaluate the accuracy and agreement of three widely used blood-loss estimation methods—visual estimation, gravimetric measurement, and the Gross formula method—against the reference HbMass method in patients undergoing posterior lumbar interbody fusion (PLIF).</p> Methods <p>A single-center retrospective cohort study included 1000 consecutive elective PLIF patients (2021–2024). Intra-operative blood loss was quantified intra-procedurally by visual, gravimetric, and Gross formula method approaches; HbMass was calculated from pre- and post-operative hemoglobin with patient blood volume estimated by the Nadler equation. Agreement was assessed with Bland–Altman 95% limits of agreement (LoA) and Spearman correlation; sensitivity analyses examined fusion extent, irrigation volume, and sampling timing.</p> Results <p>Mean blood loss was 663.8 ± 155.6&#xa0;mL by HbMass. Visual, gravimetric, and Gross estimates averaged 456.5 ± 175.0&#xa0;mL, 599.8 ± 167.5&#xa0;mL, and 608.0 ± 115.0&#xa0;mL, respectively (all P &lt; 0.001). Correlation with HbMass was negligible (ρ = 0.185), weak (ρ = 0.424), and moderate-to-strong (ρ = 0.742). Bland–Altman biases (95% LoA) were − 238.85&#xa0;mL (− 631.46, 153.76), − 45.33&#xa0;mL (− 377.55, 286.90), and − 28.57&#xa0;mL (− 216.66, 159.52). Sensitivity analyses confirmed robustness.</p> Conclusion <p>Among routine methods, the Gross formula method offers the smallest bias and narrowest agreement limits versus HbMass, whereas visual estimation is clinically unreliable. PLIF-enhanced recovery pathways should replace sole reliance on visual assessment with the Gross formula method, supplemented by HbMass in high-risk cases, to optimize peri-operative volume therapy and reduce transfusion-related complications.</p>

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Accuracy and agreement of three blood-loss estimation methods versus the HbMass method for assessing blood loss during PLIF

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月9日

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  • Qianpeng Ma,
  • Xingyu Duan,
  • Xuewei Wang,
  • Jian Liu,
  • Ningkui Niu

摘要

Objective

To evaluate the accuracy and agreement of three widely used blood-loss estimation methods—visual estimation, gravimetric measurement, and the Gross formula method—against the reference HbMass method in patients undergoing posterior lumbar interbody fusion (PLIF).

Methods

A single-center retrospective cohort study included 1000 consecutive elective PLIF patients (2021–2024). Intra-operative blood loss was quantified intra-procedurally by visual, gravimetric, and Gross formula method approaches; HbMass was calculated from pre- and post-operative hemoglobin with patient blood volume estimated by the Nadler equation. Agreement was assessed with Bland–Altman 95% limits of agreement (LoA) and Spearman correlation; sensitivity analyses examined fusion extent, irrigation volume, and sampling timing.

Results

Mean blood loss was 663.8 ± 155.6 mL by HbMass. Visual, gravimetric, and Gross estimates averaged 456.5 ± 175.0 mL, 599.8 ± 167.5 mL, and 608.0 ± 115.0 mL, respectively (all P < 0.001). Correlation with HbMass was negligible (ρ = 0.185), weak (ρ = 0.424), and moderate-to-strong (ρ = 0.742). Bland–Altman biases (95% LoA) were − 238.85 mL (− 631.46, 153.76), − 45.33 mL (− 377.55, 286.90), and − 28.57 mL (− 216.66, 159.52). Sensitivity analyses confirmed robustness.

Conclusion

Among routine methods, the Gross formula method offers the smallest bias and narrowest agreement limits versus HbMass, whereas visual estimation is clinically unreliable. PLIF-enhanced recovery pathways should replace sole reliance on visual assessment with the Gross formula method, supplemented by HbMass in high-risk cases, to optimize peri-operative volume therapy and reduce transfusion-related complications.