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

PurposeThe 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.MethodsAll 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.Results371 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).ConclusionsRadiographic bladder shift is an easily available visual marker, in patients sustaining acetabular fractures, that may predict intraoperative hemorrhage and need for transfusions.

Automated summary

The study aimed to investigate the relationship between a novel radiographic measurement (bladder shift, BS) on initial AP pelvis radiograph and intraoperative blood loss (IBL) during acetabular surgical fixation. By reviewing adult patients receiving unilateral acetabular fixation, visible bladder outlines on AP pelvis radiographs were measured to determine the percentage deformation toward the midline. The results showed that bladder shift could predict intraoperative hemorrhage and need for transfusions in patients with acetabular fractures.