Is bloodless surgery better?

Across the US, most patients having heart surgery receive blood transfusions as part of their procedure. In many heart surgery centers, up to 88% of patients get blood or blood products like red cells, platelets or other components of blood. But does over-using blood transfusion increase or decrease the risk of heart surgery and other major operations? Research indicates that avoiding blood transfusion may actually be associated with lower risk and greater safety. (See the Cleveland Clinic Study information below.)

Bloodless Medicine and Surgery at Englewood Hospital

At Englewood Hospital, bloodless heart surgery has been the standard of care since 2001. At that time the State of New Jersey granted approval for the establishment of our bloodless surgery demonstration program. Englewood Hospital has since become a referral center for bloodless surgery and for Jehovah’s Witnesses in the Northeastern US. In fact, Englewood Hospital applies bloodless surgery techniques to all patients. As a result, Englewood Hospital’s cardiac surgery program has compiled an impressive record. Our program has had zero patient deaths within 30 days of coronary bypass surgery for the last four 1- year periods, as reported by the State of New Jersey. In part because patients do not need to be Jehovah’s Witnesses to obtain the benefit of bloodless surgery, Englewood Hospital has been one of the safest places in the US to have heart surgery.

The questions and answers below offer more helpful information about bloodless surgery.

What are the drawbacks of blood transfusion?

In recent years the drawbacks of blood transfusion have become much more evident. Blood transfusion rarely causes infection from such diseases as HIV, hepatitis, and other organisms.  However, transfusions can impair the immune system and potentially cause many related problems. On the other hand, doctors have worried that withholding blood products from Jehovah’s Witnesses may increase the risk of complications or death.

How is it possible to do major surgery without blood transfusion?

Doctors have been concerned about the risks of blood transfusion and the necessity of operating on patients who refuse blood. So leaders in the field have developed techniques that permit safe heart surgery on patients that cannot accept transfusions. Many of these bloodless surgery techniques were pioneered at Englewood Hospital.

First and foremost, meticulous surgical technique must be used to prevent blood loss in the first place. Second, before a case starts, doctors will draw off several units of blood, store it in a vessel continuous with the patient’s own system, and then infuse the blood back at the end of surgery. The blood that is drawn off at the beginning of the surgery is replaced with salt solution that dilutes the patient’s blood during the surgery, so that any blood that is lost contains fewer precious red blood cells. Doctors also collect blood shed from bleeding during a case, wash and condition it, and then infuse it back into the patient at the end of surgery.

In patients who are anemic prior to surgery, doctors boost patients’ blood counts with a hormone called erythropoietin, and give extra iron and vitamins to correct the anemia before the operation.

What was the Outcome of the Cleveland Clinic Study of Bloodless Surgery

Jehovah’s Witnesses are not permitted to undergo blood transfusion under any circumstances because of their religious beliefs, so heart surgery for them is a serious challenge. Their special situation has created an opportunity to learn about the positive and negative aspects of blood transfusion, so the Cleveland Clinic undertook a 28-year study on the bloodless heart surgery experience in Jehovah’s Witnesses.

The Cleveland Clinic had operated on 322 Jehovah’s Witnesses during a 28-year period. They compared the surgical outcomes of Witnesses with an equal number of carefully matched patients. They found, somewhat surprisingly, that the patients who had bloodless surgery actually did better than matched patients who got the usual high rate of blood transfusion. Bloodless surgery patients had far fewer heart attacks, and they needed to be in the intensive care unit for less time. They spent less time on the breathing machine, and got out of the hospital sooner. Furthermore, there was a trend toward a better 1-year survival in the bloodless surgery patients. The paper was published in the AMA’s Archives of Internal Medicine on July 12, 2012.

The Cleveland Clinic has been so encouraged by these results that they are considering broadening the use of bloodless surgery techniques to all their heart surgery, much as Englewood has done for years.