Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study

Schwaiger, Michael; Wallner, Juergen; Edmondson, Sarah-Jayne; Mischak, Irene; Rabensteiner, Jasmin; Gary, Thomas; Zemann, Wolfgang

doi:10.1016/J.JCMS.2020.07.015

Title

Is there a hidden blood loss in orthognathic surgery and should it be considered? Results of a prospective cohort study

Author

Schwaiger, Michael

Wallner, Juergen

Edmondson, Sarah-Jayne

Mischak, Irene

Rabensteiner, Jasmin

Gary, Thomas

Zemann, Wolfgang

Abstract

The aim of this prospective observational study was to investigate the parameter 'hidden blood loss' (HBL) in the context of orthognathic surgery, incorporating undetected bleeding volumes occurring intra- and postoperatively. Orthognathic bleeding volumes were recorded at three different time points. At the end of the operation the visible intraoperative blood loss (VBL) was measured. Additionally, the perioperative blood loss was calculated 24 h and 48 h postoperatively using the 'haemoglobin balance method'. Analysis of the HBL was based on the difference between the visible intraoperative blood loss (VBL) and calculated blood loss (CBL), determined 48 h after surgery. 82 patients (male 33, female 49) were included in this study, of whom 41 underwent bimaxillary surgery and of whom 41 underwent Bilateral Sagittal Split Osteotomy (BSSO). Statistically significant differences with reference to the absolute bleeding volumes were found when comparing the two treatment modalities. In terms of HBL, a bleeding volume of 287.2 ml (+/- 265.9) in the bimaxillary group and 346.9 ml (+/- 271.3) in the BSSO cohort was recorded. This accounted for 32.2% (bimaxillary surgery) and 62.6% (BSSO) of the CBL after 48 h (BIMAX vs. BSSO, p < 0. 001). HBL is a valuable adjunct to record within the perioperative management of orthognathic surgery to further improve patient safety and postoperative outcomes. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of European Association for Cranio Maxillo-Facial Surgery.

Language

English

Source (journal)

Journal of cranio-maxillo-facial surgery. - Stuttgart

Publication

Stuttgart : 2021

ISSN

1010-5182

DOI

10.1016/J.JCMS.2020.07.015

Volume/pages

49 :7 (2021) , p. 545-555