• Giampaolo Perri, Giovanni Marchegiani, Federico Reich, Luca Casetti, Martina Fontana, Alessandro Esposito, Andrea Ruzzenente, Roberto Salvia, and Claudio Bassi.
• Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
• Ann. Surg. 2023 Apr 1; 277 (4): e849e855e849-e855.

ObjectiveTo provide an overview of the current practice of intraoperative blood loss (BL) estimation in hepato-pancreato-biliary (HPB) surgery.BackgroundIntraoperative BL is a major quality marker in HPB surgery and a predictor of perioperative outcomes. However, the method for BL estimation is not standardized.MethodsA systematic review was performed of original studies published between 2006 and 2021 reporting the intraoperative BL of patients undergoing pancreatic or hepatic resections. A web-based snapshot survey was distributed globally to all members of the International Hepato-Pancreato-Biliary Association (IHPBA).ResultsA total of 806 studies were included; 480 (60%) had BL as their primary outcome, and 105 (13%) had BL as their secondary outcome. However, 669 (83%) did not specify how BL estimation was performed, and 9 different methods were found among the remaining 136 (17%) studies.The survey was completed by 252 surgeons. Most of the responders (94%) declared that they systematically performed BL estimation and considered BL predictive of postoperative complications after pancreatic (73%) and liver (74%) resection. All methods previously identified in the literature were used by responders with different frequencies. A calculation based on suction fluid amounts, operative gauze weight, and irrigation was the most used method in the literature (7%) and among responders (51%). Most responders (83%) felt that BL estimation in HPB surgery needs improved standardization.ConclusionsStandardization of intraoperative BL estimation is urgently needed in HPB surgery to ensure the consistency of reporting and reproducibility.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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