Bloodless Surgery

isaacbowman writes "Dr. Charles Bridges, a Pennsylvania Hospital cardiologist, says says regarding new bloodless surgery options - "Among the benefits are reductions in recovery time, hospital stay, cost and complications -- as well as an estimated $20,000 in savings per patient." Advances in medicine have made this possible and Dr. Bridges also says, "There's no downside to it that we can see, and there's certainly no downside that's been documented." Dr. Patricia Ford, director of Pennsylvania Hospital's Center for Bloodless Medicine & Surgery, further states, why blood transfusions are dangerous, saying that they are "like getting a transplant; they can be risky and should be a last resort.""

Comments

Transfusion != Transplant

[Anonymous Coward]

As a surgical resident I found most of the article pretty good, but the last line that a blood transfusion was the same as a transplant much have been taken out of context. I have take care of nearly 100 transplant patients during my residnecy and they are by far the most labor intensive petients in the hospital. They are chronically immune suppressed, often on the verge of liver and/or kidne failure, and generally coming in erey year or so with rejection issues.
On the other hand I have taken care of hundreds of patients who have had blood transfusions. While not harmless, a blood transfusion has a miniscule risk of infection (from potential pathogens we are not aware of or cannot test for) or reaction. Only two of my patients have had transfusion reactions which requires stopping the transfusion, some medication, and maybe two extra hospital days. These patients did not need long term immune supression or chronic doses of borderline toxic medications as a result of the transfusion.

Just my little nit pick with the article.

---sam

Re:Transfusion != Transplant

[Achromatic1978]

Yeah, whilst these are also all valid, much of the time it's more simple - that the patient doesn't understand what's been written. They might see a "scrawl" because they're /expecting/ a legible word, when what is actually written may be:

"2tbdiafuf"

Or:

• 2T - 2 Tablets
• BD - "bi daily", Twice A Day
• IAF - Immediately After Food
• UF - Until Finished

When you learn this shorthhand, your problems aren't all solved, but you'll understand far more of what's going on.

JW article on Bloodless Surgery

[TheTiminator]

If you really want to investigate why bloodless surgery is gaining ground in the medical industry then take a look at this article published by Jehovah's Witnesses. And before you turn up your nose because of the source of the article, you should really give it a read. The JW's have had a major impact on how the medical industry views this topic and many advances have been made because of them. Here's the article: http://www.watchtower.org/library/hb/index.htm?art icle=article_06.htm

Cool stuff

[Pedrito]

I think it's brilliant that they're starting to use suctioned blood to resupply the patient. This is, more or less, perfectly good blood. It may need to be mixed with some anticoagulants, but otherwise it's got to be better than transfused blood. It's fresh and still plenty capable of carrying a full load of oxygen.

I'm planning on applying to med school in the next couple of years with the goal of going into surgery, so seeing an article like this on Slashdot is nice. The advancements in medicine over just the last decade have been incredible and I see no end to it. I'm looking forward to how much more it will advance by the time I'm in residency.

Re:Cool stuff

[BVis]

I used to have a job running a Cell Saver for a third party company during surgical procedures. It does provide a great benefit to the patient (as they're getting their own blood products back almost immediately, frequently while still partially oxygenated) WHEN USED PROPERLY. Most of the time it didn't eliminate the need for transfusion (especially in trauma cases, or abdominal aortic aneurysm cases which made up about 50% of our work) but frequently the blood would have to be discarded due to procedural contraindications, ie the surgical team (read as: the surgeon) would not follow the instructions given by the technician (namely, me.) I literally had one doctor suck up stomach contents into the cell saver reservoir and then be irate when I refused to process it. Another time, written instructions on an emergency reservoir setup (to be used in cases where it's needed immediately for an emergency surgical procedure, before the technician can arrive at the hospital) were not followed (in this case, the wall suction was set to "full" which destroys red blood cells and can lead to an increased risk of heart attack and/or stroke among other potentially fatal complications) leading to nearly 3 liters of suctioned material being discarded. The cutter complained to the cheif surgeon, who complained to the head of surgical services, and after a protracted investigation, it was determined that it was the right choice. Nevertheless, the same mistake was made multiple times at the same hospital after that, and despite my having made the right choice in insisting the material be discarded, that surgeon refused to allow me to be in the room while he operated after that. (Yay for surgeon arrogance; even when he's wrong, he's right.)

My point is that the cell saver is not a panacea for transfused blood. We did use it on several Jehovah's Witnesses; apparently there is some thought that if the circuit of blood is not broken (ie the suctioned material is constantly processed and immediately transfused) then there is no breach of their belief system.

thinking too literally

[everphilski]

You are thinking too deeply, their point was simply whenever possible one should avoid inserting things into the body that are foriegn, either other peoples blood or even your own blood that has been stored.

It also avoids potential problems like this. (synopsis: Red Cross Canada pleads guilty to killing over 3,000 people due to distributing tainted blood; 1000 contracted HIV, 20,000 hep-c). The less foreign substances you put in your body, the better, besides the fact that stored blood isn't nearly as effective as your own natural blood at carrying oxygen.

Re:Driving force for bloodless surgery

[JadeAuto]

That all depends on your faith. You see, some people have such faith in their beliefs that they are willing to die for them, by abstaining from any kind of blood. Many people have a problem with this. But remember, Jehovah's Witnesses are simply messengers. They aren't trying to promote any kind of violence or bloodshed. And refering to the comment about how JW's harbor child abusers, consider this: Nobody is perfect. There will always be people who make mistakes, who do wrong things, and who choose to do acts of injustice. You'll find that in every group of people, whether it be a religious group or a national group. Depending on your faith, that may or may not change soon. My faith is solid, that's for sure.

$20,000 per patient! - more like $500 per unit

[spineboy]

At least that's what most hospitals charge to the patient for predonated blood.
.
That $20,000 sounds like it's been pulled out of someone's exagerated butt - maybe for a very, very, very bloody heart transplant. Probably >90% of operations don't require a blood transfusion.

I'm an orthopaedic surgeon, and for those of you who don't know, most orthopaedic surgeries tend to resemble Aztec ceremonies. But anyway, my last 20 knee and hip replacements haven't required a transfusion. Most patients who do need a transfusion - i.e. bloody messes scraped off the pavement after being ejected from their car wreck, only need about 2-4 units.

Would it be cool if we found a safe, effective blood substitute? - yes. But today the risks from transfusion are approximately 1 in 350,000 of being exposed (not catching) hepatitus, and 1 in 2,000,000 exposure to the HIV. In other words, don't worry about it, your risk of being hit by lightning is about the same.

Not just for religion

[MachDelta]

Okay, yes, good on Jehovah's Witnesses for reinforcing the desire for these types of procedures, but stop and think that this might not just be a religious issue. Theres a whole 7% of the population out there who, like me, are type O negative. And while we may be wonderful/magical/mythical creatures capable of donating our blood to anyone other human being on the planet (especially handy during time-critical emergencies), we are unfortunately incapable of accepting red blood transfusions from anyone BUT an O- donor.

So this is also good news to some of us who may be concerned with limited supplies of compatible blood in an a system already struggling to meet demand. Hooray.

Re:Dr. Bridges said it best...

[Hitman_Frost]

Hi.

I've been sitting reading and re-reading your comment, and wondering what it is you're actually trying to say here.

The only idea I've had so far is that you're possibly disputing that the "bloodless" description of the surgery is incorrect terminology? Have I misunderstood this point?

Please clarify this comment, as I don't see why this would need an insane-sounding rant at the end.

If I've got it wrong, let me know, as I'd like to know what could have provoked such an extreme and intense comment.

Thanks.