Bloodless Surgery

Medical innovations that work!

When my brother had major surgery a number of years ago, a significant decision prior to the surgery was whether or not to donate some of his own blood for fear of needing a transfusion. But what if that extra blood wasn't a necessary part of the equation? What if new surgical techniques, new equipment and a better understanding of the body's reliance on hemoglobin meant that many surgeries -- especially elective surgeries -- no longer required transfusions of donated blood? Sound unrealistic? Guess again. The truth is, bloodless surgery is a reality that's gaining popularity among surgeons and patients alike. And its definitely something you need to know about.

HOW IT WORKS
Technology has paved the way for bloodless surgery -- it simply wouldn't be an option without some of the cutting-edge instruments and surgical techniques currently available. This includes minimally invasive surgeries such as extracorporeal shock wave lithotripsy, which uses high-energy sound waves to break up kidney stones. Bloodless surgery also may involve groundbreaking new scalpels like the harmonic scalpel (using ultrasound waves) and microwave-coagulating scalpel, which seal bleeding blood vessels as they cut... cryosurgery, which freezes (and thus destroys) the tissue that would normally be cut out... the gamma knife, which uses precision radiation to destroy tumors or abnormal vessels... and relatively new "cell saver" machines that collect the small amount of blood lost during these surgeries or after, clean it and return it to the patient.These technologies are so efficient that, according to Patricia A. Ford, MD, medical director of The Center for Bloodless Medicine and Surgery at Pennsylvania Hospital in Philadelphia, even complex surgeries can now be done without transfused blood. "More complex surgeries can be performed, such as open heart surgeries, liver transplants, even orthopedic procedures, which are normally quite bloody," she explains. "We've not yet encountered any particular type of elective surgery that cannot use these technologies." (Note the word "elective," however. Even Dr. Ford says that, in acute trauma situations, blood transfusions may be the only life-saving options available.)

BACKERS OF BLOODLESS
Bloodless surgery isn't exactly new, as the techniques and related technologies have been used and developed for more than a decade, partly for the benefit of Jehovah's Witnesses, whose religious beliefs prevent them from accepting blood transfusions. But there are other groups who support the development of bloodless surgery, as well. "There are individuals who will decline transfusions for various reasons," explains Dr. Ford. "including the fear of infection and other complications. But doctors also request bloodless surgery for their patients, because they recognize there's still a risk associated with transfusions and they want to be able to offer their patients alternatives."Another reason bloodless surgery is vital is the shortage of donated blood. The American Red Cross, for example, faces an increasing number of blood-supply shortages each year as the whole population lives longer and more elective and necessary surgeries are performed. "They suspect that, within the next 10 or so years, we're not going to be able to meet the needs of our population for elective procedures," says Dr. Ford. "These blood products are becoming increasingly unavailable." And bloodless surgery provides a solution to the shortage so that necessary surgeries that may call for donated blood can still be done, with minimal impact on overall blood supply

FEW RISKS -- AND BIG SAVINGS"
Personally, I think there are very few risks with bloodless surgery," says Dr. Ford. The biggest risk, obviously, is blood loss. But healthy adults can usually lose up to 20% of their normal blood volume without suffering permanent damage to vital organs, and the technology mentioned above minimizes the risk of massive bleeds. Still, the risk of excessive bleeding is something to consider and talk to a surgeon about -- Are you willing to receive a transfusion if the need arises? Fortunately, such complications are rare. When Dr. Ford compared bloodless surgery patients to those who received traditional surgery, she found that the bloodless surgery patients not only didn't have an increased mortality risk, but they actually had shorter stays in the hospital. The bloodless procedures even reduced the overall costs associated with surgery, which isn't hard to understand as the per-unit cost of blood often hovers between $200 and $500. While there is a cost to the equipment, and likely to training, you don't need a special surgeon -- any surgeon can use the equipment -- so the costs are not ongoing. So, overall, and especially over time, there is a savings due to the shorter hospital stays and less blood use. "Hospital administrators are increasingly interested in this," says Dr. Ford. "Many hospitals have a $2 million or $3 million budget for blood... even a 10% reduction in blood use can really have a significant impact."

WORK TO BE DONE
Solid research -- including significant large-scale clinical trials -- into each of the various forms of bloodless surgery has yet to be conducted or evaluated, says Dr. Ford. She admits that it's the next step proponents of bloodless surgery need to take, if they hope to further promote their blood-saving methodologies. "There are over 120 bloodless surgery centers across the country that have been operating independently," she explains. "We need to pool our data and information and publish the results if we want to change the standard of care." That work is underway -- and the face of surgery is changing.

If you're interested in bloodless surgery and want to find a hospital near you, visit the Society for the Advancement of Blood Management Web site at www.sabm.org... and, talk to your doctor about your surgery options.