DIAGNOSTIC BLOOD-LOSS IN THE PATIENT UNDERGOING HEAD AND NECK-SURGERY

Objective: To examine retrospectively the amount of blood lost solely for diagnostic purposes in a defined group of patients. Design: Retros pective medical chart review of a case series. Setting: Operating thea ter and surgical intensive care unit in a major tertiary care center. Patients: Thirty-nine consecutive patients with head and neck. cancer undergoing major surgical procedures and requiring overnight intensive care unit monitoring. Main Outcome Measures: Patient medical records were analyzed for procedure, starting hematocrit reading, intraoperati ve estimated blood loss and intravenous fluids, operative time, histor y of blood product transfusion, blood lost for each phlebotomy encount er, and the immediate cost therefrom. Results: The mean diagnostic blo od loss was 181 mL, which was 36% of estimated blood loss. In the grou p of 23 nontransfused patients, the average drop in hematocrit was 9.7 %. This change in hematocrit correlated most strongly with operating t ime (P<.02) and the amount of intraoperative intravenous fluid adminis tration (P<.05). The average cost to the patient directly from phlebot omy-associated charges was $542. Conclusions: Diagnostic blood loss co ntributes significantly to the overall blood loss in the patient under going head and neck surgery.