The Benefits of Bloodless Surgery
Date: November 1, 2013
A new mission at Johns Hopkins aims to promote more bloodless surgeries, using methods that reduce the need for transfusions.
“We’re seeing that we can do a lot more with less blood during surgery and afterward,” says anesthesiologist Steven Frank, medical director of
The Johns Hopkins Hospital’s Center for Bloodless Medicine and Surgery.
“Our aim is to reduce transfusions by 10 to 20 percent throughout our medical system.”
The tactics used don’t only benefit those who refuse transfusions for personal concerns about contamination or for religious beliefs, says Frank: “We’ve come to see bloodless surgery as best practice
for more patients in general.” There is a new trend nationwide toward blood conservation, which lowers risk and costs, and improves outcomes, he says.
Landmark Studies in Bloodless Surgery
Driving the new goal are five landmark studies—the most recent including Johns Hopkins data. Each trial followed large numbers of sick patients experiencing blood loss during hospital stays, comparing survival based on whether or not hemoglobin levels had been boosted by transfusions.
“The bottom line,” says Frank, “was that patients held to a lower hemoglobin reading before getting transfusions did just as well or better than those transfused at a traditional higher triggering point. We see no advantages in routinely giving extra blood. All you do is introduce cost and risk.”
Transfused patients are two to three times more likely to get acquired infections, he says, and receiving donor blood sparks antibodies that work against future transfusions.
In addition, new research from Frank and colleagues shows that blood starts becoming “stale” after three weeks—far before the common blood bank shelf-life of six weeks. Red blood cell membranes stiffen, which can slow passage of red blood cells through capillaries.
One of the program’s aims is reducing blood bank demand. This means going beyond modern tactics that recycle blood lost during surgery, shrink operating fields through robotics or beef up patients’ presurgical red cell count. Tactics are increasingly patient-tailored. And research continues on best practice. A large hospital database, for example, showed Frank’s team how a simple $9 IV-based device used on one Johns Hopkins critical care unit halved blood loss due to laboratory testing.