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Background  Patients undergoing complex spine surgery present with multilevel spinal involvement, advanced age, and multiple comorbidities. Surgery is associated with significant blood loss and remarkable hemodynamic changes. The present study aimed to investigate the accuracy and trending ability of a non-invasive continuous method to monitor hemoglobin (SpHb) concentrations using a Radical-7™ Pulse CO-Oximeter in complex spine surgery.    Methods  Forty-nine patients who underwent complex spine surgery were enrolled in this prospective observational study. Multiple time points were established for data collection throughout the operation. Simultaneous SpHb–total hemoglobin (tHb) paired data were recorded for analyses. Linear regression analysis, Bland–Altman plot, four-quadrant plot, and Critchley polar plot were used to assess the accuracy and trending ability of the monitor.    Results  A total of 272 pairs of SpHb-tHb data were available and were divided into two groups based on the perfusion index (PI): PI values ≥1.0 ( n  = 200) and PI values < 1.0 ( n  = 72). The correction coefficients (r) between SpHb and tHb were 0.6946 and 0.6861 in the groups with PI values ≥1.0 and < 1.0, respectively ( P  < 0000.1). In the ≥1.0 group, the mean bias was − 0.21 g/dL and the percentage error (PE) was 15.85%, whereas in the < 1.0 group, the mean bias was − 0.04 g/dL and the PE was 17.42%. Four-quadrant plot revealed a concordance rate of 85.11%, whereas the Critchley polar plot showed a concordance rate of 67.21%.    Conclusions  The present study demonstrates the acceptable accuracy of the Radical-7™ Pulse CO-Oximeter even with a low PI. However, the trending ability was limited and unsatisfactory.

Validity of accuracy and trending ability of non-invasive continuous total hemoglobin measurement in complex spine surgery: a prospective cohort study