A medical device used in surgeries reduces need for blood transfusions during hip and knee replacements.
A bloodless hip or knee replacement may sound like science fiction, but the truth is, it’s more important than ever for doctors to control bleeding during surgery. With the cost of hospital stays going up and reimbursement going down, healthcare providers are looking for ways to help orthopedic patients recover as quickly as possible from medical procedures.
When patients bleed a lot during surgery, they often need a blood transfusion, which is a common cause of higher hospital costs and longer stays. “The criterion that ‘triggers’ the need for a transfusion is multifactoral,” explains Dr. Giles R. Scuderi, a knee reconstructive surgeon with the North Shore-LIJ Health System in New York and consultant for Medtronic.
Scuderi states, “For the last several years, the transfusion criteria used have been completely arbitrary. The truth is, evidence has shown us that for the vast majority of patients, outcomes are improved, including quicker mobilization and rehabilitation, when the need for a blood transfusion is eliminated.1-4 In cases where they are required, each transfusion must be evaluated for the potential risk of post-operative complications it could cause the patient.”
One solution that’s helping doctors control surgical blood loss is the Aquamantys System, which uses Transcollation technology to provide hemostatic sealing of soft tissue and bone during surgery. A generator transmits a combination of radio frequency energy and saline to a hand-piece that the doctor moves across the bleeding tissue or bone, touching the electrodes to the tissue for a few seconds at a time. The hemostatic sealing process reduces active bleeding.
Constance Squibb, a former coordinator of the blood management program at a Savannah, Ga., hospital, states that blood transfusions are better described as liquid connective tissue transplants from one human being to another. “Even though they are very common during or after surgery, blood transfusions are complicated and expensive procedures,” Squibb explains. “The average cost of a hospital stay for surgery that includes a transfusion can be nearly 10% to 15% higher.4”
As hospitals continue looking for ways to cut costs, products like the Aquamantys System are providing new solutions. “As part of a comprehensive approach to reduce intra-operative blood loss, I use the Aquamantys System in my total knee replacement cases,” Scuderi says. “During these types of procedures, blood loss is the primary reason patients need a transfusion. Using the Aquamantys System helps me control that blood loss, which means there’s less of a chance that we’ll need to transfuse our patients.5-6 It’s hard to argue against that logic when the value is found with less swelling and pressure, as well as less pain for many of our patients.”
Scuderi’s approach proactively manages patient outcomes toward quicker recovery and reduced hospital costs. A recent study conducted at University of Pittsburgh Medical Center with more than 50 surgeons and more than 3,700 patients showed that overall hospital charges averaged $14,000 more for patients who had joint surgery that included a transfusion than for patients who did not need a transfusion.7
Medtronic Advanced Energy continues to introduce new devices that are powered by the Aquamantys Generator. Some are designed specifically for certain types of surgery. In addition to hip and knee replacements, the system is used in spine, orthopedic trauma, and surgical oncology procedures.
1. Rosenberg AG. Reducing blood loss in total joint surgery with a saline-coupled bipolar sealing technology. J Arthrop 2007; 22(4):82-85.
2. Bierbaum BE, Callaghan JJ, Galante JO et al. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone & Joint Surg 1999;81:2-10.
3. Gross T, Liu F, Webb L. Comparison of unilateral and rapidly staged bilateral resurfacing arthroplasty. Acta Orthop Belg 2011; 77(2):203-210.
4. Covance report; 2008 MedPAR database based on ICD-9-CM Codes for 100% of Medicare beneficiaries.
5. Marulanda GA, Ulrich SD, Seyler TM et al. Reductions in blood loss with a bipolar sealer in total hip arthroplasty. Expert Rev Med Devices 2008; 5(2):125-131.
6. Marulanda GA, Ragland PS, Seyler TM et al. Reductions in blood loss with use of a bipolar sealer for hemostasis in primary total knee arthroplasty. Surg Tech XIV 2005; 12:281-286.
7. Chen AF, Klatt BA, Yazer MH et al. Blood utilization after total knee arthroplasty in a large hospital network. Poster presentation at American Association of Hip and Knee Surgeons Annual Meeting 2011; Dallas, TX.