ArticleJournal of orthopaedic surgery and research2026
Accuracy and agreement of three blood-loss estimation methods versus the HbMass method for assessing blood loss during PLIF.
Article in Journal of orthopaedic surgery and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo 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).
methodsA 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.
resultsMean 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.
conclusionAmong 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.
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