Blood Wasted When Saved for Neurosurgery
Better techniques require less, but hospitals still stock up
THURSDAY, April 4, 2002 (HealthDayNews) -- Precious blood is going to waste because hospitals order far more than is needed for head and neck surgeries -- and often end up throwing it out.
University of Virginia neurosurgeons say that, thanks to improved surgical techniques, doctors have reduced by 50 percent the amount of blood they keep on hand during operations. However, the blood-ordering policies haven't kept up with the medical advances, and much of the extra blood never gets used.
"We'd been ordering a lot and using very little blood during surgery. It was just waste, at great cost and utilization of a scarce resource," says Dr. Neal F. Kassell, lead author of a study appearing in tomorrow's issue of Stroke.
A research team led by Kassell, co-chairman of the university's Department of Neurosurgery, tried to determine how much of the blood routinely ordered for several common neurosurgeries was actually used.
The researchers reviewed the records of 301 patients who had undergone brain surgery at the University of Virginia in Charlottesville. They found that for all the operations, 952 units of red blood cells had been ordered in case transfusions were needed. However, only 176 units were used. This means they were ordering 5.4 times more blood than was used.
In one of the operations, where surgeons clear blocked arteries in the neck, 252 units of red blood cells were ordered to back up 126 operations, but only five units were used.
The reason, Kassell says, is the recommendations for how much blood should be available during operations "hadn't been updated for 20 years. At the same time, over the last two or three decades there has been an increase in microsurgery, which is less invasive and where we can control the bleeding much better."
The problem with ordering extra blood goes beyond its cost. The blood set aside for operations often ends not being used at all. Each unit of blood targeted for an operation undergoes three tests to make sure it's compatible with the patient's blood, a time-consuming and costly process.
One of the tests, a cross-match where the patient's red blood cells are mixed with the purchased blood to insure its compatibility, reduces the amount of time the blood can be safely used, Kassell explains.
In addition, when blood is set aside for a surgery, it is unavailable to other patients for one to two days. The older blood gets, the less effective it is in delivering oxygen to the body's tissues -- and the more likely it will be discarded.
Kassell says that following his study his department has reduced its purchase of extra blood by 50 percent, ensuring that each patient still has access to transfused blood, but cutting back on waste. Any more reduction would mean that some patients would have no blood on standby, which wouldn't be safe.
"When you have a potentially life-threatening situation, you need to have some blood on hand," he says, even if it is not used.
"This way, it doesn't create any safety issues, we're saving money, and we're not tying up as much blood," he says. "We hope that other institutions will update their blood-use policies."
"I'm very happy with this study," says Dr. Celso Bianco, executive director of America's Blood Centers, an association of 75 independent blood centers that collect nearly half the blood supplies in the United States. "It calls attention to the issue, and shows the opportunity for change. Tranfusion blood use is lower than it was three or four years ago, but there is still room for improvement."