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Bloodless Surgery 226

Posted by samzenpus
from the walk-it-off dept.
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.""
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Bloodless Surgery

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  • I'll bet (Score:3, Funny)

    by voice_of_all_reason (926702) on Wednesday April 26, 2006 @08:41PM (#15209331)
    $20,000 in savings per patient

    That dull roar you just heard outside was the US's entire population of medical residents placing a revolver in their mouth and pulling the trigger.
    • Re:I'll bet (Score:5, Funny)

      by the_humeister (922869) on Wednesday April 26, 2006 @08:51PM (#15209370)
      That dull roar you just heard outside was the US's entire population of medical residents placing a revolver in their mouth and pulling the trigger.


      And there goes the $20,000 savings per patient...
    • Re:I'll bet (Score:3, Insightful)

      by MindStalker (22827)
      Hardly... The savings is realized in two ways.
      1. Less risk so the doctors insurance cost are less (SOME of this savings will be passed on to you)
      2. Quicker recovery time so your hospital room stay will be shorter. This only means quicker turn around time so they can push for more surgeries.
      • Re:I'll bet (Score:3, Insightful)

        by AuMatar (183847)
        Hi. Welcome to corpoatism. None of the savings will be passed on to you, or to the doctor. The CEO of the malpractice insurance corp will get a bigger bonus.
      • Re:I'll bet (Score:2, Insightful)

        by modecx (130548)
        I agree with #2, but #1? If there is any universal truth, it's that insurance bills never go down!
      • You know, now that we have more free space in the hospital, I'd really like to talk to you about that rhinoplasty. I know, you came in as a cancer patient, but, since there's more free space, I can offer you a great deal on a new nose.

        Also, have you ever thought about a tummy tuck?

        I have a couple of organs that I'd like to unload as well.


        I can see this working out real well for the used organ salesmen...
    • and keep the medics' earnings up otherwise they will not have said there is no downside.

      How do they get a 20k saving per patient? They must be selective in what they're quoting because most surgical procedures cost way less than 20k.

      • Odds are good the '20k in savings' is either an average savings (and hence including the ever-expensive organ transplants and other risky surgeries) or else it's a cumulative savings from the following:
        • Red Cross doesn't have to expend as much effort into attracting donors with gimmicks like t-shirts and other contests when that money could be put into more useful 'core' purposes.
        • Less transportation issues and cooling needed for fewer amounts of blood to circulate, which also means a lack of emissions, veh
        • Odds are good the '20k in savings' is either an average savings (and hence including the ever-expensive organ transplants and other risky surgeries) or else it's a cumulative savings from the following:

          * Red Cross doesn't have to expend as much effort into attracting donors with gimmicks like t-shirts and other contests when that money could be put into more useful 'core' purposes.


          My understanding is that a unit of blood costs $500 Australian dollars - in a system that doesn't p
          • My understanding is that a unit of blood costs $500 Australian dollars - in a system that doesn't price blood for sale or pay donors to donate.

            The costs will be higher in countries that do (eg., USA)


            The USA doesn't buy blood either. Bought blood in the USA can only be used for non-human testing purposes. Anything to be used in a human being has to be donated.

            There are provisions for funding red cross for the actual collection purposes.

            It might seem strange, but blood products intended for research can be
            • The Red Cross makes huge profits off its blood monopoly. They also abuse that monopoly by creating artificial shortages - blood freezes well, but they won't allow that to happen. In fact, in the US, the RC doesn't sell even blood to hospitals, it leases it: if blood isn't transfused, the hospitals have to give it back after a certain period. (The EULA on blood is even worse than on software.)
    • They mentioned valve replacement, which can be done on a beating heart without the use of a heart and lung machine. [jeromegroopman.com] Doesn't help JWs, but is much easier on your body.
  • The sad part... (Score:2, Interesting)

    by GillBates0 (664202)
    The sad part is that this procedure works only on Vulcans [wikipedia.org].
  • by Anonymous Coward on Wednesday April 26, 2006 @09:09PM (#15209446)
    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
    • by everphilski (877346) on Wednesday April 26, 2006 @09:28PM (#15209528) Journal
      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 [bbc.co.uk]. (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.
    • I agree, but this is mostly due to the fact that the transfused blood cells quickly die off and are discarded by the body, replaced by the host's own blood cells. The implanted organs are supposed to survive for years, and thus are a constant source of irritation to the body's immune system.
    • by Anonymous Coward on Wednesday April 26, 2006 @09:30PM (#15209537)
      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.

      • by brianerst (549609) on Wednesday April 26, 2006 @09:48PM (#15209600) Homepage
        The official position of the church is that you cannot use any of the major blood fractions (red or white blood cells, plasma or platelets), but the use of certain blood fractions (animal hemoglobin, interferon, interleukin, etc.) is left up to personal conscience.

        A handy chart for the various blood related things JWs may or may not use can be found here [adam.com].

        • Thx for the link,

          I just evaluated a JW for a kidney transplant, and the issue of blood loss/blood transfusion over the course of surgery came up. They themselves were unclear as to what is and isn't acceptable as it related to the specific procedure the patient was being evaluated for (Kidney Transplant). Certainly something they will need to speak with the transplant team and their church's leadership, but the link was helpful for me nonetheless.

          take care,
          jeff
    • Actually, they said it was "like" a transplant, not "the same as" a transplant. "like" does not mean "the same as" and this is an important distinction.

      Just my little nit pick with your comment.
  • Old technology (Score:2, Insightful)

    by dorpus (636554)
    "Keyhole surgery" generated some fanfare a few years ago, but the reality is that it is more dangerous than open surgery, requiring greater skill. How the hell do you operate on something you can't see, digging around under flesh?
    • How the hell do you operate on something you can't see, digging around under flesh?

      It's easy. Say "marco" and the diseased part will answer "polo", guiding you to your destination.

      Or maybe use ultrasound or a floroscope. The marco polo thing is way funner.
    • you can see. Them little fibre optic camera gizzmos have been around for at least 30 years.
  • by Maradine (194191) * on Wednesday April 26, 2006 @09:13PM (#15209468) Homepage
    I can guarantee you, the only party involved in the process who will see that twenty grand is the insurance industry.

    M
    • A large amount of insurance these days is provided in package form. A company buys an insurance plan for all employees through a given insurer. They then insure everyone, without prescreening. The insurance companies do this because it's lucrative, and odds are you get more healthy employees than unhealthy ones.

      Well, of course, companies put this out to bid. They don't want to pay anymore than they have to since they generally pick up most or all of the cost. So insurance companies will give them as good a
    • If I owned an insurance company and saw a significant reduction in costs (many $20k savings per year), and my competitors did not change their prices, I would lower my prices to increase my customer base, thereby stealing customers from the competition. This would give me the same profit margin as before, but I would be making much more money overall.

      I've noticed cynicism is often used to create the illusion of intelligence...
      • You'd get a visit from the other insurance companies.

        Keep in mind they're colluding to raise prices wherever possible. See, many of them invested the money people paid to them in dot com stocks, expecting to quintuple their money overnight, get fantastically wealthy, etc.

        When the dot bombs TANKED and people STILL put in requests for you know, like, payment - that's when they started denying claims and taking medications and that off what they'll cover and not cover. Hell, many of them deny payment the first
        • If that is the case, then that is illegal. If there is evidence of it someone will probably sue them under anti-trust laws. Also, I would expect insurance start-ups to appear eventually.

          Your idea seams plausable. But lacking evidence, it is just a theory.
          • RE: If that is the case, then that is illegal. If there is evidence of it someone will probably sue them under anti-trust laws. Also, I would expect insurance start-ups to appear eventually.

            So is the current price gouging by oil companies, but you won't see that, or Microsoft, prosecuted any time soon.
  • by TheMadWeaz (949464) on Wednesday April 26, 2006 @09:15PM (#15209477) Homepage
    after bloodless surgery comes fluidless sex [wikipedia.org].
  • "Among the benefits are reductions in recovery time, hospital stay, cost and complications -- as well as an estimated $20,000 in savings per patient."

    Not to mention stretching the blood supply for the patients this doesn't help ... a 27-unit obstetrical disaster, or a gut-shot cop.

    • by spineboy (22918) on Wednesday April 26, 2006 @10:29PM (#15209797) Journal
      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.

      • The 20k number does not seem that off to me. The 90% that don't need a transfusion don't count. It depends on the product etc but if a unit of blood costs a hospital ~500$ and on average you use 3 - 4 then you start at 1.5-2k but you need to add in all the other costs.

        EX: If treating HIV cost's 2mill then your adding 1$ per unit of blood as a hidden cost. Even if only 2 people get AIDS from blood per year the cost of treating them must be added into the mix. Let alone the cost of being sued over such an
  • by TheTiminator (559801) on Wednesday April 26, 2006 @09:22PM (#15209509) Homepage
    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 [watchtower.org]
    • by a_nonamiss (743253) on Wednesday April 26, 2006 @10:47PM (#15209866)
      Speaking from personal experience, my mother-in-law ruptured her spleen and didn't go to the doctor for 2-4 weeks. (She didn't know when she ruptured it.) She bled internally for this entire time, eventually ending up unconscious in the Emergency Room from blood loss, where they decided it needed to be removed. My in-laws are extremely devout Jehovah's Witnesses, and refused any sort of transfusion. The doctor told my father-in-law "Your wife will die without a transfusion. She's lost too much blood." They opted for blodless surgery anyways.

      Keep in mind that I do not personally subscribe to these beliefs, but this is what I, as an outsider, observed: (Anecdotal, yes, but it's all I have to go on.) They called in their best surgeon. The surgery took much longer than a "normal" splenectomy. The surgeon took extra time and went slow. All the internal sutures had to be extra clean to avoid blood loss. Even the external sutures were done with great care. They were so careful with blood loss that she lost less than half a pint of blood through the whole procedure. (Almost all of that half-pint was in the spleen, or so the surgeon said.) My mother-in-law survived the surgery. (although it was pretty dicey for about 24 hours - the hospital told the family to make sure her "affairs were in order.") She recovered in record time. No complications. Even the scar was less visible than a typical surgery scar.

      So regardless of religious views, it seems to me that if you request a bloodless surgery, you get better medical care. Rather than trying to chop you up and sew you back together as quickly as possible to free up the operating room for the next job, everyone involved seems to slow down and take things easy. You become that pain in the ass exception that they need to take extra special care of. Rather than run you through the mill, they have to take you off the assembly line, look at your special needs. I still doubt that I personally would opt for a bloodless surgery, but it really gave me pause to think about the whole idea.
      • "So regardless of religious views, it seems to me that if you request a bloodless surgery, you get better medical care. Rather than trying to chop you up and sew you back together as quickly as possible to free up the operating room for the next job, everyone involved seems to slow down and take things easy. You become that pain in the ass exception that they need to take extra special care of. Rather than run you through the mill, they have to take you off the assembly line, look at your special needs. I s
        • Your point is well taken. Like I said, that story was purely anecdotal, and if I had to have surgery, I think I would opt for whatever would be more likely to keep me alive. Also, if everyone opted for bloodless surgery, it would become just as routine. The only reason you get special treatment now is because it's "something different."
      • by shawb (16347) on Thursday April 27, 2006 @01:04AM (#15210336)
        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.
        • 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.

          Agreed, for the most part. However, the quote of "$20,000 cheaper", would, on average indicate that these issues are less indicative than the benefits of taking their time and doing it the 'bloodless' way. Besides savi
      • They called in their best surgeon. The surgery took much longer than a "normal" splenectomy. The surgeon took extra time and went slow.

        So regardless of religious views, it seems to me that if you request a bloodless surgery, you get better medical care.

        In other words, the time of a specialist was taken up for a case where his expertise wasn't really required. Someone else didn't receive the benefit of that surgeon, and an operating theatre and all of the support personnel (anaesthesiologist(s), nurses,

  • Cool stuff (Score:5, Interesting)

    by Pedrito (94783) on Wednesday April 26, 2006 @09:28PM (#15209525) Homepage
    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.
    • This is called a Cell Saver, and it's been used for years and years.

      Nothing new here. Move on.

      • Re:Cool stuff (Score:4, Interesting)

        by BVis (267028) on Thursday April 27, 2006 @07:31AM (#15211185)
        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.
  • by SensitiveMale (155605) on Wednesday April 26, 2006 @09:52PM (#15209619)
    on a lawyer?
  • Glad to see the doctors are finally putting away their butcher knives! :P
  • by MachDelta (704883) on Wednesday April 26, 2006 @11:00PM (#15209912)
    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.
  • by sohp (22984)
    This isn't especially new. For a number of reasons (most of which I no longer subscribe to) I did not have blood given when I had major open heart surgery in 1979. Of course, I had one of the world's best surgeons in a top pediatric cardiological facility, so the difference may be mainstream vs. high-risk, but there's nothing but the medical field's tradition that would keep the practice from becoming common.

    What's actually happened though, is that most surgery now is minimally invasive -- except for a few
  • by morie (227571) on Thursday April 27, 2006 @04:12AM (#15210711) Homepage
    This is bad news for Antonio, and Shylock will be quite pleased.

  •   I thought there were plenty of surgeons doing "bloodless" operations,
      from years ago, in response to the need of groups like Jehovah's Wit-
      nesses NOT to allow blood transfusions into members of their faith.

      This doesn't seem like a "news" article to us... :-/

      It would be one of the examples of religious tradition necessitating
      innovation in [here, medical] technology.

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