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.""

Don't get too exited.

[Maradine]

I can guarantee you, the only party involved in the process who will see that twenty grand is the insurance industry.

M

Re:Bloodless Surgery?

[Rachel Lucid]

From TFA:

• The patients have the iron content in their blood enhanced in order to better cope with the procedure (same as in a blood donation).
• During the surgery, various non-bleedy and less bleedy techniques (such as cauterizing as you cut, and freezing the tissue to stop blood flow) to reduce the amount of blood you lose in the first place.
• They recover what DOES get spilled and recycle it so you use your own blood during the procedure instead of having to donate in advance.

The artices does go ahead and admit that the more complex a procedure, the less likely this is possible: so a full-on heart transplant is far less likely to be bloodless than, say, an appendectomy or a stomach reduction (or other similar surgeries that don't require large incisions).

Re:Driving force for bloodless surgery

[brianerst]

Speaking as someone who has family members who are Jehovah's Witnesses, they really are the driving force for bloodless surgery.

Jehovah's Witness have a theological objection to blood transfusions [watchtower.org], but unlike Christian Scientists, not to medical treatment in general. In fact, they are quite insistent on high quality healthcare [watchtower.org].

As such, they advocate [watchtower.org] the use of blood transfer alternatives.

There are various groups of Witnesses that advocate changing the doctrine [ajwrb.org], but, however odd it may seem to the rest of us, it's one of core teachings of the church and has survived even when other once-rejected medical technologies (organ transplants, certain immunizations) have now been accepted.

This doctrine has caused the Witnesses to push the medical community to come up with many alternatives to transfusion. These alternatives include Erythropoietin Therapy [nejm.org], Hemopure, a bovine-hemoglobin based blood substitute [anesthesiologyinfo.com] (this was quite a surprise, as previously even animal blood was considered taboo), perfluorocarbon based blood substitutes [watchtower.org] (back when I was young, I knew Witnesses who had been guinea pigs for this stuff), and a host of others [adam.com]. There are also specific surgical guidelines [unipi.it] published in dealing with Witnesses.

All in all, the Witnesses are one of the main driving forces for research into lessening the need for blood transfusions. There are others to be sure (type matching, blood shortages, infectious diseases carried by tainted blood, etc.), but nothing beats having a large pool of otherwise healthy patients who are highly motivated to be test subjects.

Re:Transfusion != Transplant

[Anonymous Coward]

I did my internship at Pennsylvania Hospital. The bloodless program is great. I think Pat Ford's quote is a little much, but, on the other hand, blood transfusions are more than just an issue of a little transfusion reaction. There are a number of other antigens on the cells (besides those for "blood type" with which can people react. The trouble is, this can raise the risk of transfusion reactions later on in life, if the need arises for another transfusion. Folks who need transfusions chronically for some reason or another can get to the point where you have to test for all kinds of antigens, then wait 3 days for that one unit of blood to come from Louisiana. In general, you definitely want to limit the number of times that you get transfused, so that when/if you really need the blood, you won't have a problem. All you need is to have some horrible motor vehicle accident, get 10 units of blood, then get a hemolytic reaction on top of your other problems.

BTW: Jehovah's Witnesses vary in terms of their religious beliefs around transfusion. For some, some components of blood can be transfused, but not others, whereas other patients are more stringent.

Re:Driving force for bloodless surgery

[Anonymous Coward]

As one of Jehovah's Witnesses who has twice faced a serious blood-loss I can tell you how happy I am to see advances like this. Actually as a Witnesses, we give a lot of credit to courageous doctors who took on difficult cases without having the option of transfusing. The issue is actually surprisingly broad -- involving things like informed consent and various patient rights concerns. In regards to blood being a vector for pathogens, this is certainly well known, but our stand is purely religous based (based on the Biblical mandate expressed in Acts 15:29 and elsewhere). In my own case I was so glad to have avoided a transfusion in Canada during the early 80s, just before the AIDs-tainted blood supply issue became known. Canada was behind other countries, such as the US in implementing AIDS/HIV testing to routine blood screening. Ironically, even though I know live in the US, I had an accident while on vacation in Canada in 2001 which required emergency surgery. I can tell you that while I did fine, many hospitals in Canada simply can not afford some the equipment mentioned in the artical.

Re:Bloodless Surgery?

[x2A]

Yeah that got me for a while too... by bloodless it more means blood-transfusion-less; there is obviously blood involved, but only the patients own.

Old, but modified and state of the art tech

[spineboy]

In many (not all) cases "keyhole" surgery (laparoscopic - in the belly, or Arthroscopic - in a joint), actually allows a BETTER view than the traditional open procedure.
Every joint procedure (knee or shoulder 'scope) allows the surgeon a better view than the open method,'cause the camera is so small, it can get into many places, that you normally can't even see. Gallbladder surgery now is overnight or same day, as compared to a one to two week stay for the open method.

And yes, I am a surgeon , and I have done both open and closed shoulder repairs, and the 'scope method is waaaaay better. You can see more anatomy, more pathology, less blood loss, and less tissue damage. Trust me, we all need to sleep at night, and want what's best for the patient.

Re:JW article on Bloodless Surgery

[shawb]

While the "chop you up and sew you back together" paradigm may seem like it is out of greed on the part of the surgeons, decreasing surgery time does prevent many benefits to the patient as well. Simply having the surgery site open for less time would, in theory, lead to less complications due to blood loss, tissue oxidation and contamination. Surgical anaesthetics are not "good for you" and the less time spent on the table, the lower the risk from complications with these chemicals.