Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation

Natalie L Zusman; Danielle F Peterson; Michelle M Lawson; Natasha S McKibben; David M Gallacher; Darin M Friess; Zachary M Working

doi:10.1007/s00590-023-03617-8

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Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation

Journal article

Peer reviewed

Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation

Natalie L Zusman, Danielle F Peterson, Michelle M Lawson, Natasha S McKibben, David M Gallacher, Darin M Friess and Zachary M Working

European journal of orthopaedic surgery & traumatology, Vol.34(7), pp.3447-3453

10/2024

DOI: 10.1007/s00590-023-03617-8

PMID: 37314503

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Abstract

The purpose of this study was to characterize the relationship between a novel radiographic measurement on initial AP pelvis radiograph (termed "bladder shift," BS) to intraoperative blood loss (IBL) during acetabular surgical fixation. All adult patients receiving unilateral acetabular fixation (Level 1 academic trauma; 2008-18) were reviewed. AP pelvis radiographs were reviewed for visible bladder outlines and then measured to determine the percentage deformation toward the midline. Hemoglobin & hematocrit data were then used to calculate quantitative blood loss between pre- and post- operative blood counts for data analysis. 371 patients with unilateral traumatic acetabular fractures requiring fixation were reviewed; 99 of these had visible bladder outlines, complete blood count and transfusion data (2008-2018; 66% associated patterns). Median bladder shift (BS) was 13.3%. Every 10% of bladder shift was associated with 123 mL greater IBL. Patients with full bladder shift to midline sustained a median 1.5L IBL (interquartile range [IQR] 0.8 to 1.6). Associated patterns had a threefold greater median BS (associated: 16.5% [15.4 to 45.9] vs. elementary: 5.6% [1.1 to 15.4], p < 0.05) and received intraoperative pRBC twice as frequently (57% vs. 24%, p < 0.01). Radiographic bladder shift is an easily available visual marker, in patients sustaining acetabular fractures, that may predict intraoperative hemorrhage and need for transfusions.

Acetabulum - diagnostic imaging

Acetabulum - injuries

Acetabulum - surgery

Adult

Blood Loss, Surgical

Blood Transfusion - statistics & numerical data

Female

Fracture Fixation, Internal - adverse effects

Fracture Fixation, Internal - methods

Fractures, Bone - diagnostic imaging

Fractures, Bone - surgery

Humans

Male

Middle Aged

Radiography - methods

Retrospective Studies

Urinary Bladder - diagnostic imaging

Urinary Bladder - injuries

Details

Title: Subtitle: Radiographic bladder shift is a harbinger of intraoperative blood loss in acetabular surgical fixation
Creators: Natalie L Zusman - Oregon Health & Science University
Danielle F Peterson - Oregon Health & Science University
Michelle M Lawson - Oregon Health & Science University
Natasha S McKibben - Oregon Health & Science University
David M Gallacher - Oregon Health & Science University
Darin M Friess - Oregon Health & Science University
Zachary M Working - Oregon Health & Science University
Resource Type: Journal article
Publication Details: European journal of orthopaedic surgery & traumatology, Vol.34(7), pp.3447-3453
DOI: 10.1007/s00590-023-03617-8
PMID: 37314503
NLM abbreviation: Eur J Orthop Surg Traumatol
ISSN: 1633-8065
eISSN: 1432-1068
Language: English
Date published: 10/2024
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984949480102771

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