797 Estimated Blood Loss in Burns: A Quality Metric That Defies Measurement?

Abstract

Abstract Introduction There are a handful of publications over the past 3 decades evaluating single institution blood loss during excision and grafting procedures (E/G) for thermal injuries. The average estimated blood loss (EBL) reported ranges from 0.75ml/cm2 excised to 9.2% total blood volume/1% E/G, with disparate standard deviations. EBL should be benchmarked and evaluated for improvement in quality metrics. Methods We performed a retrospective evaluation of 66 burn E/G cases. They were analyzed for blood loss at 24 and 72 hours post procedure, accounting for any intra-operative or immediate post-operative transfusions using the Mercuriali formula. Each unit of transfused blood was estimated to increase hemoglobin 1g/dL. Results Means and standard deviations for calculated EBL, taking into account transfused blood and ongoing donor site bleeding up to 72 hours is depicted in Table 1. EBL in < 20% TBSA and >20% TBSA cases were compared as well as those with and without tourniquet use. Means and standard deviations for calculated EBL, taking into account transfused blood and ongoing donor site bleeding up to 72 hours is depicted in Table 1. EBL in < 20% TBSA and >20% TBSA cases were compared as well as those with and without tourniquet use. Conclusions Benchmark quality measures for burn should include EBL. These preliminary data suggest that results could guide intraoperative transfusion decisions if enough cases are analyzed (data collection is ongoing). Evaluation of EBL may also provide insight for transfusion ratios for coagulopathy of burn. Applicability of Research to Practice Evaluation of blood loss during surgical treatment of thermal injuries is an important benchmark and its study may lead to improvements in care.