Validated Intraoperative Bleeding Scale (Vibe Scale): Relevance and Utility in Gynecological Surgery

Abstract

Study Objective This study investigates the reliability and repeatability of using a Validated Intraoperative Bleeding Scale (VIBe SCALE) to assess intraoperative bleeding by gynecological surgeons. This scale describes bleeding using rate and nature of blood loss, which are thought to improve blood loss estimates. Design Through an online platform, surgeons self-trained on the VIBe SCALE and then graded 15 videos with known rates of blood loss. A Kendall's W was calculated for inter-observer agreement (reproducibility) using ten unique videos within the video set and intra-observer agreement (repeatability) using five duplicate videos within the video set. Setting N/A Patients or Participants Eight surgeons board certified in obstetrics/gynecology and eight board certified in gynecological oncology participated. Mean years of experience was 16.1 years (range 4-30, N=16), and majority reported using hemostatic agents in practice (15/16, 94%). Interventions N/A Measurements and Main Results Inter- and intra-observer agreement was “excellent” with values of 0.92 and 0.99, respectively. Majority of surgeons accurately graded blood loss in 5 of 10 unique videos; accuracy improved when a video was repeated, with majority correctly grading blood loss in 4 of 5 duplicate videos. Of the four domains within the scale, visual presentation was the most used (16/16, 100%) and considered most relevant (12/16, 75%). Rate of blood loss was the second most used (13/16, 81%) and considered the second most relevant (3/16, 19%). Conclusion Surgeons can grade bleeding using the VIBe SCALE with excellent reliability, and their accuracy improved with use. This supports that surgeons can more accurately assess blood loss by considering the rate and nature of blood loss rather than volume. Use of the VIBe SCALE may also improve early recognition of bleeding, increase communication within the operating room about bleeding and expedite the treatment of bleeding.