New “Gold Standard” Improves Outcomes for Elective Surgery Patients
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Research carried on for decades in the U.S. and Europe has resulted in a new “gold standard” for elective surgery that significantly improves patient care, lowers costs and saves lives. It is practiced regularly in leading medical centers across America, including Massachusetts General Hospital, The Johns Hopkins Hospital and The Cleveland Clinic, as well regional teaching hospitals like Hartford Hospital, Rhode Island Hospital, Pennsylvania Hospital and New Jersey’s Englewood Hospital, which pioneered its use. It has become the official standard of treatment of the U.S. military for elective surgery.[i]
This new “gold standard” is actually an updated and improved version of a nineteenth century practice: bloodless medicine and surgery. According to surgeon Nathaniel Usoro, MD:
Kocher, MDVirtually all surgeries prior to the 20th century were essentially ‘bloodless.’ And some were remarkably successful. Theodore Kocher, for instance, did his first thyroidectomy in 1872, and by the end of his career he had done 5000 thyroidectomies with only 1% mortality. Kocher never transfused any patient and he won a Nobel Prize.[ii]
Dr. Kocher’s procedures were safe and successful because he meticulously avoided unnecessary bleeding. The new bloodless surgery does that as well using up to date technology. In addition, it often makes use of the patient’s own blood, which at one time was thrown away during surgery. It is “bloodless” because it avoids costly transfusions of donated blood that actually produce lower success rates than procedures that salvage the patient’s own blood. As Dr. Usoro continues, “Many clinicians are surprised to learn that blood transfusion is based on tradition and associated with a poorer outcome (unrelated to infectious hazards) in a wide variety of patients.”[iii]
But isn’t blood “The Gift of Life?”
gift of lifeMarketing campaigns have trained most Americans to believe that “blood is the gift of life.” And for some patients with massive traumatic blood loss, transfusions of donated blood can indeed prove to be lifesaving. Around the time of World War I, when medical researchers learned how to safely store blood for weeks and match it correctly to patients, a new era in medicine was born. Bloodless surgical techniques were set aside as transfusions became an automatic feature of modern surgery. It appeared to be a genuine improvement.
surgeryBut then physicians conducted studies to compare outcomes of those who underwent what had become traditional surgery including transfusions with those who had the same procedures without blood. This crucial body of research revealed that bloodless surgery patients experience substantially fewer complications, shorter hospital stays and faster recoveries.
Speaking at a medical conference Dr. Joseph Sweeney, Professor of Pathology and Laboratory Medicine at Brown University and Director, Coagulation and Transfusion Services for the Lifespan hospital group made these important points:
Studies show that patients who are anemic at the time of surgery have poorer outcomes.
Blood transfusions do not improve the prognosis for most anemic patients, as once widely believed.
Research has revealed a previously unknown transfusion risk that bloodless surgical techniques can eliminate. [iv]
capillaryBlood banks have worked hard to reduce the chance of transmitting blood borne infections through transfusions, with varying degrees of success. But research has uncovered another risk that is hard to avoid without using bloodless surgery. Dr. Sweeney explained that red blood cells stored for just six days become rigid. Transfusions can hinder circulation through a patient’s capillaries, the tiny blood vessels that bring oxygenated blood to sustain individual cells.
The Journal of the American Medical Association stated, “Some studies actually indicate no increase in tissue oxygenation with blood transfusion.”[v] Rigid red cells can stop up tiny capillaries, actually starving the cells they were transfused to nourish.
Cleveland ClinicA major research study of patients who underwent heart bypass surgery at The Cleveland Clinic supports this conclusion. Those whose doctors used bloodless surgical methods were much less likely to suffer serious complications than those who had traditional bypass surgery with transfusions of packed red blood cells. Summing up their detailed findings, researchers wrote:
Our results suggest that transfusions should be avoided to the extent possible.[vi]
It has now become clear that transfusions of donated blood, even carefully screened and washed red cells, increases the risk of serious complications. New surgical methods are needed. Fortunately, these were developed over the years by innovative surgeons and anesthesiologists. They were willing to take on the challenge of operating on patients who refused blood transfusions, most notably Jehovah’s Witnesses who were determined to obey the biblical injunction to “abstain from blood.”[vii]
Denton CooleyPatients who steadfastly refused blood transfusions formed a pool of experimental subjects, “human guinea pigs” who permitted doctors to try new procedures so that they could have the surgery they needed without violating their consciences. One willing surgeon was Dr. Denton Cooley, who performed the world’s first heart transplant in 1968. He also pioneered bloodless open heart surgery and later wrote:
We became so impressed with the results on the Jehovah’s Witnesses that we started using the procedure on all our heart patients. We’ve had surprisingly good success and used it in our [heart] transplants as well.[viii]
How the new gold standard is carried out
Ired blood cells2n his presentation at the 2009 New England Regional Society for the Advancement of Blood Management Conference, Dr. Sweeney outlined a simple procedure for the new gold standard, bloodless elective surgery. Since anemia revealed by a low blood count reduces the likelihood of a successful procedure, it’s important to check and, if necessary, build up patients’ blood 4-5 weeks before surgery.
Blood counts can be raised by administering iron supplements, either in pill form or intravenously. In some cases, patients receive erythropoietin (EPO), a medication that speeds up their natural red blood cell production. Surgery will be scheduled when blood counts reach the acceptable range.
Cell Saver
During the procedure, doctors will employ equipment that minimizes blood loss. This includes cell salvage equipment that suctions up blood leaking from the wound, cleans it, and returns it to the patient’s circulation. Instead of throwing away the patient’s blood, as done for years, the medical staff cleanses and reinfuses it. There is nothing better for a patient than their own fresh red blood cells, far safer than donated blood (or even the patient’s own stored blood).
If the patient’s blood count is still low, EPO administration will begin to raise it within a few days.
Conclusion
leaving hospitalBloodless medicine and surgery provides many advantages to both patients and the healthcare system. It significantly improves outcomes, reducing the risk of complications. It shortens hospital stays and promotes quicker recoveries. Further, it saves healthcare dollars, an important consideration as baby boomers retire and Medicare membership grows.
Major medical centers, regional teaching hospitals and the U.S. military have all embraced the new gold standard. If you’re considering elective surgery it might well pay dividends to ask your doctor if it’s appropriate to use bloodless medicine and surgery in your case.
By MICHELLE CASTILLO CBS NEWS July 3, 2012, 3:03 PM
Jehovah's Witnesses who refuse blood transfusions after cardiac surgery at no greater health risk:
CBS News) New research shows that Jehovah's Witnesses who refuse blood transfusions after cardiac surgery are at no greater health risks than people who undergo the procedure.
The study, which was published in the Archives of Internal Medicine on July 2, intended to look at patients who do not undergo blood transfusions after cardiac surgery. Because Jehovah's Witnesses believe on religious grounds that they are not supposed to ingest the blood of another, they made ideal test subjects.
The study looked at 48,986 non-Witnesses who had blood transfusions and 322 Witnesses who refused to have blood transfusions who all underwent cardiac surgery between 1983 to 2011. After matching the patients up by similar cases, researchers found both groups had similar risks for dying at the hospital. However, Witnesses had lower chances of having additional operations for bleeding, renal failure and sepsis compared with non-Witnesses who received transfusions.
"It behooves us to examine more closely some Jehovah Witness processes of care and implement them in our routine surgeries," study author Dr. Colleen Koch, a cardiothoracic anesthesiologist at Cleveland Clinic in Ohio, said to HealthDay.
Witnesses spent less time in the intensive care unit and less time in the hospital than the other group. They also had higher survival rates compared to the people who were non-witnesses at 95 percent and 89 percent respectively. Both groups had close 20-year survival rates (34 percent versus 32 percent).
According to the Mayo Clinic, blood transfusions can cause a number of health complications, including allergic reactions, fevers, lung injury, spread of bloodborne infections and acute immune hemolytic reaction - a rare transfusion reaction in which a person's body attacks the new blood because it's not the proper type. But, HealthDay points out that screening techniques introduced in the 1990s have made it safer than it previously was.
Transfusion is typically ordered because of the risk of anemia - which the National Institutes of Health defines as a condition where the body does not have enough red blood cells. Anemia can cause the person to feel tired or weak, have headaches and shortness of breath, as well as problems concentrating or thinking.
Dr. Victor A. Ferraris, a professor of cardiothoracic surgery at the University of Kentucky, wrote in an accompanying commentary that the study shows that it might do doctors well to look at their own practices.
"The findings of this analysis by Pattakos and colleagues add to the increasing data that suggest that more conservative use of blood transfusions would be in our patients' interest, in both Witnesses and non-Witnesses," he stated.
But, Dr. Gregory Fontana, chair of cardiothoracic surgery at Lenox Hill Hospital in New York City, warns HealthDay that the results don't indicate that we should expand the findings to everyone.
"just because this paper is published, we cannot willy nilly start treating everyone like Jehovah's Witnesses," he told HealthDay. "It does provide further evidence that transfusion with real indication carries a risk that heretofore has been underestimated."
larryrondeauwriting business writing
Research carried on for decades in the U.S. and Europe has resulted in a new “gold standard” for elective surgery that significantly improves patient care, lowers costs and saves lives. It is practiced regularly in leading medical centers across America, including Massachusetts General Hospital, The Johns Hopkins Hospital and The Cleveland Clinic, as well regional teaching hospitals like Hartford Hospital, Rhode Island Hospital, Pennsylvania Hospital and New Jersey’s Englewood Hospital, which pioneered its use. It has become the official standard of treatment of the U.S. military for elective surgery.[i]
This new “gold standard” is actually an updated and improved version of a nineteenth century practice: bloodless medicine and surgery. According to surgeon Nathaniel Usoro, MD:
Kocher, MDVirtually all surgeries prior to the 20th century were essentially ‘bloodless.’ And some were remarkably successful. Theodore Kocher, for instance, did his first thyroidectomy in 1872, and by the end of his career he had done 5000 thyroidectomies with only 1% mortality. Kocher never transfused any patient and he won a Nobel Prize.[ii]
Dr. Kocher’s procedures were safe and successful because he meticulously avoided unnecessary bleeding. The new bloodless surgery does that as well using up to date technology. In addition, it often makes use of the patient’s own blood, which at one time was thrown away during surgery. It is “bloodless” because it avoids costly transfusions of donated blood that actually produce lower success rates than procedures that salvage the patient’s own blood. As Dr. Usoro continues, “Many clinicians are surprised to learn that blood transfusion is based on tradition and associated with a poorer outcome (unrelated to infectious hazards) in a wide variety of patients.”[iii]
But isn’t blood “The Gift of Life?”
gift of lifeMarketing campaigns have trained most Americans to believe that “blood is the gift of life.” And for some patients with massive traumatic blood loss, transfusions of donated blood can indeed prove to be lifesaving. Around the time of World War I, when medical researchers learned how to safely store blood for weeks and match it correctly to patients, a new era in medicine was born. Bloodless surgical techniques were set aside as transfusions became an automatic feature of modern surgery. It appeared to be a genuine improvement.
surgeryBut then physicians conducted studies to compare outcomes of those who underwent what had become traditional surgery including transfusions with those who had the same procedures without blood. This crucial body of research revealed that bloodless surgery patients experience substantially fewer complications, shorter hospital stays and faster recoveries.
Speaking at a medical conference Dr. Joseph Sweeney, Professor of Pathology and Laboratory Medicine at Brown University and Director, Coagulation and Transfusion Services for the Lifespan hospital group made these important points:
Studies show that patients who are anemic at the time of surgery have poorer outcomes.
Blood transfusions do not improve the prognosis for most anemic patients, as once widely believed.
Research has revealed a previously unknown transfusion risk that bloodless surgical techniques can eliminate. [iv]
capillaryBlood banks have worked hard to reduce the chance of transmitting blood borne infections through transfusions, with varying degrees of success. But research has uncovered another risk that is hard to avoid without using bloodless surgery. Dr. Sweeney explained that red blood cells stored for just six days become rigid. Transfusions can hinder circulation through a patient’s capillaries, the tiny blood vessels that bring oxygenated blood to sustain individual cells.
The Journal of the American Medical Association stated, “Some studies actually indicate no increase in tissue oxygenation with blood transfusion.”[v] Rigid red cells can stop up tiny capillaries, actually starving the cells they were transfused to nourish.
Cleveland ClinicA major research study of patients who underwent heart bypass surgery at The Cleveland Clinic supports this conclusion. Those whose doctors used bloodless surgical methods were much less likely to suffer serious complications than those who had traditional bypass surgery with transfusions of packed red blood cells. Summing up their detailed findings, researchers wrote:
Our results suggest that transfusions should be avoided to the extent possible.[vi]
It has now become clear that transfusions of donated blood, even carefully screened and washed red cells, increases the risk of serious complications. New surgical methods are needed. Fortunately, these were developed over the years by innovative surgeons and anesthesiologists. They were willing to take on the challenge of operating on patients who refused blood transfusions, most notably Jehovah’s Witnesses who were determined to obey the biblical injunction to “abstain from blood.”[vii]
Denton CooleyPatients who steadfastly refused blood transfusions formed a pool of experimental subjects, “human guinea pigs” who permitted doctors to try new procedures so that they could have the surgery they needed without violating their consciences. One willing surgeon was Dr. Denton Cooley, who performed the world’s first heart transplant in 1968. He also pioneered bloodless open heart surgery and later wrote:
We became so impressed with the results on the Jehovah’s Witnesses that we started using the procedure on all our heart patients. We’ve had surprisingly good success and used it in our [heart] transplants as well.[viii]
How the new gold standard is carried out
Ired blood cells2n his presentation at the 2009 New England Regional Society for the Advancement of Blood Management Conference, Dr. Sweeney outlined a simple procedure for the new gold standard, bloodless elective surgery. Since anemia revealed by a low blood count reduces the likelihood of a successful procedure, it’s important to check and, if necessary, build up patients’ blood 4-5 weeks before surgery.
Blood counts can be raised by administering iron supplements, either in pill form or intravenously. In some cases, patients receive erythropoietin (EPO), a medication that speeds up their natural red blood cell production. Surgery will be scheduled when blood counts reach the acceptable range.
Cell Saver
During the procedure, doctors will employ equipment that minimizes blood loss. This includes cell salvage equipment that suctions up blood leaking from the wound, cleans it, and returns it to the patient’s circulation. Instead of throwing away the patient’s blood, as done for years, the medical staff cleanses and reinfuses it. There is nothing better for a patient than their own fresh red blood cells, far safer than donated blood (or even the patient’s own stored blood).
If the patient’s blood count is still low, EPO administration will begin to raise it within a few days.
Conclusion
leaving hospitalBloodless medicine and surgery provides many advantages to both patients and the healthcare system. It significantly improves outcomes, reducing the risk of complications. It shortens hospital stays and promotes quicker recoveries. Further, it saves healthcare dollars, an important consideration as baby boomers retire and Medicare membership grows.
Major medical centers, regional teaching hospitals and the U.S. military have all embraced the new gold standard. If you’re considering elective surgery it might well pay dividends to ask your doctor if it’s appropriate to use bloodless medicine and surgery in your case.
By MICHELLE CASTILLO CBS NEWS July 3, 2012, 3:03 PM
Jehovah's Witnesses who refuse blood transfusions after cardiac surgery at no greater health risk:
CBS News) New research shows that Jehovah's Witnesses who refuse blood transfusions after cardiac surgery are at no greater health risks than people who undergo the procedure.
The study, which was published in the Archives of Internal Medicine on July 2, intended to look at patients who do not undergo blood transfusions after cardiac surgery. Because Jehovah's Witnesses believe on religious grounds that they are not supposed to ingest the blood of another, they made ideal test subjects.
The study looked at 48,986 non-Witnesses who had blood transfusions and 322 Witnesses who refused to have blood transfusions who all underwent cardiac surgery between 1983 to 2011. After matching the patients up by similar cases, researchers found both groups had similar risks for dying at the hospital. However, Witnesses had lower chances of having additional operations for bleeding, renal failure and sepsis compared with non-Witnesses who received transfusions.
"It behooves us to examine more closely some Jehovah Witness processes of care and implement them in our routine surgeries," study author Dr. Colleen Koch, a cardiothoracic anesthesiologist at Cleveland Clinic in Ohio, said to HealthDay.
Witnesses spent less time in the intensive care unit and less time in the hospital than the other group. They also had higher survival rates compared to the people who were non-witnesses at 95 percent and 89 percent respectively. Both groups had close 20-year survival rates (34 percent versus 32 percent).
According to the Mayo Clinic, blood transfusions can cause a number of health complications, including allergic reactions, fevers, lung injury, spread of bloodborne infections and acute immune hemolytic reaction - a rare transfusion reaction in which a person's body attacks the new blood because it's not the proper type. But, HealthDay points out that screening techniques introduced in the 1990s have made it safer than it previously was.
Transfusion is typically ordered because of the risk of anemia - which the National Institutes of Health defines as a condition where the body does not have enough red blood cells. Anemia can cause the person to feel tired or weak, have headaches and shortness of breath, as well as problems concentrating or thinking.
Dr. Victor A. Ferraris, a professor of cardiothoracic surgery at the University of Kentucky, wrote in an accompanying commentary that the study shows that it might do doctors well to look at their own practices.
"The findings of this analysis by Pattakos and colleagues add to the increasing data that suggest that more conservative use of blood transfusions would be in our patients' interest, in both Witnesses and non-Witnesses," he stated.
But, Dr. Gregory Fontana, chair of cardiothoracic surgery at Lenox Hill Hospital in New York City, warns HealthDay that the results don't indicate that we should expand the findings to everyone.
"just because this paper is published, we cannot willy nilly start treating everyone like Jehovah's Witnesses," he told HealthDay. "It does provide further evidence that transfusion with real indication carries a risk that heretofore has been underestimated."
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