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Bloodless Surgery Grows in Popularity
More physicians today are turning to bloodless surgery, also referred to as blood conservation, because it is believed to be often healthier, safer and less costly for patients than standard surgical procedures.
Dr. Denton Cooley performed the first bloodless heart surgery in 1962. Since that time, bloodless surgeries and blood conservation programs have typically been reserved for patients who rejected blood transfusions for religious reasons. Recently, mainstream patients are becoming more attracted to these techniques due to fear of diseases that can be traced to blood transfusions.
When these concerns arise, some physicians pursue a bloodless surgical route, prescribing drugs that raise blood levels before an operation, using blood diversion techniques during procedures and employing other methods to conserve a patient’s own blood.
Today, there are more than 100 hospitals in the United States with blood management programs. In 2002, that number was only 70.
A Need for Bloodless Surgery?
As patient awareness about the risks of blood transfusions increase, so does the demand for bloodless surgery.
In fact, the statistics for blood transfusion can be alarming when it comes to health. Heart surgery patients are twice as likely to die during the first 30 days of hospitalization if they receive a blood transfusion for anemia, according to a study published in the Journal of the American Medical Association. Heart bypass patients who receive blood transfusions are also twice as likely to acquire an infection after their operation, according to a study in the journal BMC Medicine. Overall, the study found that 16% of patients who received a transfusion developed an infection after their operation, as compared to 7% of patients who did not have a blood transfusion acquired an infection. Additionally, the risk of contracting hepatitis B is about 1 in 205,000, according to the National Heart Lung and Blood Institute, and the risk for hepatitis C is 1 in 2 million. The Institute states that if a patient receives blood during a transfusion that contains hepatitis, he or she will most likely develop the virus.
One explanation as to why blood transfusions are linked to higher death rates is that the chemicals in donor blood suppress a patient's immune system, making it more difficult to fight off infections. Within hours of being collected, red blood cells stiffen up, making it harder for them to squeeze down narrow blood vessels and supply oxygen to the body’s organs. In one study published in the New England Journal of Medicine, patients who received blood that was more than two weeks old were nearly 70% more likely to die within a year than patients who received freshly donated blood.
What Bloodless Surgery Advocates Say
Physicians who practice bloodless surgical techniques and facilities where bloodless surgery is offered report many advantages for patients, including:
- Safety. Since the blood being transfused belongs to the patient, the patient is not at risk of developing disease due to donor blood.
- Lower cost. Because patients tend to recover from bloodless surgery more quickly than a standard operation, patients spend less time in the hospital and are able to return to work quicker.
- Availability. Doctors and patients don’t have to worry about whether the blood they need will be available on the day of surgery.
To prepare a candidate for surgery, the patient must follow medicinal and nutritional guidelines in order to increase his or her blood count before surgery. This is to prevent the risk of anemia following the operation.
In spite of these advantages, some patients will not be able to avoid a transfusion. In cases of severe trauma or anemia, for instance, transfusions remain the appropriate course of action. There is also some controversy surrounding the transfusion “trigger,” the point at which a patient must have a transfusion.
Physicians have traditionally called for a transfusion if the patient’s hemoglobin level falls below 10 grams per deciliter and definitely if the level reaches 8 grams/dl. Some advocates, however, say it’s safe to hold off on a transfusion in an otherwise healthy patient until his or her level falls much lower.
Guidelines for blood transfusions vary and are subject to interpretation, so many physicians rely on their own assessment as to when a transfusion must be performed. Many physicians are waiting for long-term data and clear guidelines about when to order a transfusion for a patient.