Introduction: Surgical management of burn patients with extensive wounds frequently consists of multiple surgeries at times with significant blood loss. Quantifying intra-operative blood loss accurately allows for timely resuscitation and replacement. Estimated blood loss is the value used to that end; yet its reliability in burn surgery is not determined.

Methods: A retrospective multi-center study was conducted to identify adult patients (>17 years old) with greater than 15% TBSA burn requiring surgical management who presented from January of 2015 to January of 2019. Demographic data including age, gender, as well as burn etiology, percent of total body surface area burned (%TBSA), area treated with autografts, number of surgeries, and presence of inhalational injury, number of days in the hospital, and occurrence of complications were gathered. Estimated blood loss was compared through regression analysis to 1) number of blood products used, 2) change in hemoglobin, and 3) calculated blood loss using hemoglobin balance formula, hemoglobin dilution formula, and Gross formula.

Results: Correlation was noted between EBL, calculated blood loss using hemoglobin dilution formula, and total blood product used. EBL as well as the total number of blood products used and calculated blood loss using hemoglobin dilution formula correlated with %TBSA, area treated with autograft skin, length of time in hospital, as well as inhalational injury. Neither correlated with age, gender, and etiology of burn. EBL correlated with development of complications including DVT/PE and GI bleed while total blood products use did not.

Conclusion: Following the proper algorithm, EBL can be an important tool in planning transfusion and fluid replacement in patient with significant burn wounds.