Abnormal Bleeding in the Cardiac Operating Room: An Observational Study of Inter-Rater Reliability Between Anesthetists and Surgeons

This French nationwide observational study evaluated the inter-rater reliability between 47 cardiac surgeons and 54 anesthetists in assessing post-cardiopulmonary bypass (CPB) bleeding using 17 intraoperative video clips. The investigators utilized Gwet’s AC1 coefficient to measure agreement on bleeding perception, residual coagulopathy, and the decision for immediate hemostatic transfusion. Reliability for identifying abnormal bleeding was “moderate” overall (γ=0.47) but dropped significantly to “poor” for ambiguously abnormal cases (γ=0.20). Notably, intra-dyad agreement for immediate transfusion in clearly abnormal situations was six times lower than in ambiguous ones (OR=0.18). The authors thus concluded that situational awareness regarding intraoperative hemorrhage appears to be suboptimal, necessitating standardized cognitive tools and interdisciplinary training to reduce transfusion practice variability and enhance patient safety.