title: Clinical evaluation of a novel system for monitoring surgical hemoglobin loss.
abstract: BACKGROUND
  Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, blood lost onto laparotomy sponges during surgical cases was measured using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. In this study, we assessed the accuracy and performance of the system in surgical cases.
  
  
  METHODS
  In this prospective, multicenter study, 46 patients undergoing surgery with anticipated significant blood loss contributed laparotomy sponges for hemoglobin (Hb) loss measurement using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Los Altos, CA). The Hb loss measured by the new system was compared with that measured by manual rinsing of the sponges. Accuracy was evaluated using linear regression and Bland-Altman analysis. In addition, the new system's calculation of blood volume loss was compared with the gravimetric method of estimating blood loss from intraoperative sponge weights.
  
  
  RESULTS
  A significant positive linear correlation was noted between the new system's measurements and the rinsed Hb mass (r = 0.93, P < 0.0001). Bland-Altman analysis revealed a bias of 9.0 g and narrow limits of agreement (-7.5 to 25.5 g) between the new system's measures and the rinsed Hb mass. These limits were within the clinically relevant difference of ±30 g, which is approximately half of the Hb content of a unit of allogeneic whole blood. Bland-Altman analysis of the estimated blood loss on sponges using the gravimetric method demonstrated a bias of 466 mL (overestimation) with limits of agreement of -171 and 1103 mL, due to the presence of contaminants other than blood on the laparotomy sponges.
  
  
  CONCLUSIONS
  The novel mobile monitoring system provides an accurate measurement of Hb mass on surgical sponges as compared with that of manual rinsing measurements and is significantly more accurate than the gravimetric method. Further study is warranted to assess the clinical use of the technology.
authors.affiliation: From the Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas; †Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; ‡Department of Anesthesiology, Santa Clara Valley Medical Center, San Jose, California; §Department of Anesthesiology and Critical Care, Englewood Hospital and Medical Center, Englewood, New Jersey; ‖Gauss Surgical, Inc., Los Altos, California; Departments of ¶Anesthesiology and #Bioengineering, University of Pittsburgh School of Medicine; and **The McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Allen A
authors.initials: AA
authors.lastname: Holmes
authors.forename: Gerhardt
authors.initials: G
authors.lastname: Konig
authors.forename: Vicki
authors.initials: V
authors.lastname: Ting
authors.forename: Bridget
authors.initials: B
authors.lastname: Philip
authors.forename: Thomas
authors.initials: T
authors.lastname: Puzio
authors.forename: Siddarth
authors.initials: S
authors.lastname: Satish
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D005260:Female; D006452:Hemoglobinometry / Q000295:instrumentation*; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D011446:Prospective Studies; D013514:Surgical Procedures, Operative; D015503:Surgical Sponges