Accuracy of non-invasive haemoglobin measurements in patients undergoing transurethral resection of prostate surgery

BACKGROUND AND AIMS: The aim of this study was to evaluate the accuracy of non-invasive haemoglobin (SpHb) compared to laboratory venous haemoglobin (tHb) measurements among patients undergoing elective transurethral resection of prostate (TURP) surgery under spinal anaesthesia. METHODS: In a prospective, observational, outcome-assessor blinded, cohort trial, we enroled 50 American Society of Anesthesiologists physical status (ASA-PS) I-II patients with benign prostatic hyperplasia. The primary outcome included SpHb and tHb measurements performed at four perioperative time-points: just before initiating the fluid preload (T1), and at 30 min (T2), 1 h (T3), and 2 h (T4) after starting the prostate resection, respectively. Statistical tool included intra-class correlation (ICC), Bland-Altman plots, and linear regression analysis. RESULTS: We collected 200 SpHb/tHb data sets from 50 patients. The SpHb had a non-significant negative bias of –0.83 g/dL, –0.43 g/dL, –0.81 g/dL, and –0.46 g/dL, with limits of agreement of 2.6 g/dL to –4.2 g/dL, 2.4 g/dL to –3.3 g/dL, 1.3 g/dL to –2.8 g/dL, and 1.4 g/dL to –2.3 g/dL, for T1 to T4, respectively. The SpHb/tHb pairs correlated significantly (time-dependent increase in ICC from T1 to T4). The SpHb-tHb difference correlated significantly with corresponding serum sodium (T1 to T3), but not with perfusion index. No correlation existed between % change in SpHb-tHb difference (T1 to T4), and intraoperative blood loss or perioperative weight gain. CONCLUSION: The SpHb exhibited a clinically acceptable negative bias compared to tHb during TURP surgery. Although a wide limit of agreement between the SpHb/tHb pairs is a limitation, the real-time SpHb trends can still serve in clinical judgement.