Blood loss during pancreatic surgery: defining minimal clinically significant difference using standardized estimation

Résumé fourni par la source

Estimated blood loss (EBL) is a routinely recorded intraoperative parameter in pancreatic surgery, frequently associated with important postoperative outcomes including red blood cell transfusion (RBCT) and major morbidity (MM)1,2. However, EBL interpretation is inconsistent, as estimation methods vary across institutions and providers3, and there are no universally accepted thresholds for minimal clinically significant difference (MCSD) meaningful for the patients4. This study aimed to distinguish statistically detectable from clinically relevant changes in EBL during pancreatic surgery, identifying ranges that correspond to meaningful risk elevation in end outcomes. We examined the association between intraoperative EBL and two major postoperative outcomes of 30-day RBCT and MM (Clavien–Dindo ≥ III), using a large, bi-institutional cohort of patients undergoing pancreatectomy with prospectively collected, standardized EBL data. EBL was calculated following the recommendation of the recent consensus by the European–African Hepato-Pancreato-Biliary Association (E-AHPBA)5, by summing the volume of fluid collected in suction canisters, subtracting the amount of irrigation fluid used; and the volume estimated from surgical gauze, calculated from standardized weight differences between dry and used gauze. Multivariable logistic regression with restricted cubic splines modelled the relationship between EBL and outcomes, adjusting for age, sex, Charlson Comorbidity Index, preoperative aneamia, diagnosis, and resection type. Adjusted relative risks (aRRs) were derived from the spline-based regression model (Supplementary Methods).

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