Medical centers increase use of 'bloodless' surgical procedures.

L.A. COUNTY - A few weeks ago, Good Samaritan Hospital held a public seminar on its bloodless medicine program. It drew more than 200 people, close to the capacity of its auditorium.

To spur further interest, Good Samaritan recently produced and distributed a packet of market materials that included glossy brochures with a multicolored logo for its Bloodless Medicine Center and a slick 15-minute videotape with testimonials from patients who underwent bloodless surgery.

That Good Samaritan is putting forth such a marketing effort for what has always been a niche program is a dramatic departure from the past.

Simply put, bloodless medicine is a surgical procedure without the use of transfusions. It's achieved through a combination of cauterizing scalpels that cut with a minimum of bleeding, equipment that returns lost blood back into the patient's body, and drugs that stimulate red platelet production.

Twenty-five years ago, any bloodless procedure - much less open heart surgery - was impossible. It was rare in the 1980s. Now, at least in the Los Angeles area, it is becoming commonplace.

Around the same time Good Samaritan's program came on line in January 1995, several other local hospitals began offering bloodless programs of their own. Among them, Whittier Hospital Medical Center; St. Luke's Medical Center in Pasadena; Brotman Memorial Medical Center in Culver City; and Western Medical Center in Anaheim.

The first three are owned by Nashville, Tenn.-based OrNda Healthcare Corp., which is expanding the practice of bloodless medicine throughout much of its nationwide hospital network.

There are also two Los Angeles-area medical groups with medical staff that specialize in bloodless techniques: the Bloodless Options Medical Group Inc., which is affiliated with Whittier Hospital, and the Kay Medical Group, which is affiliated with Good Samaritan.

Latest techniques

Hospital officials say bloodless surgery allows their medical staffs to push the envelope of cutting-edge technologies and surgical techniques. They claim patients tend to recover substantially faster from bloodless surgery, something that health maintenance organizations and other managed care insurance carriers find attractive.

"Bloodless surgery has been called the gold standard of health care, said Daniel Friedman, OrNda's director of bloodless medicine programs.

Friedman claimed bloodless surgery can cut five or six hours out of a patient's stay in the intensive care unit, and two to three days off the typical six-or seven-day hospital stay following open heart surgery, something that Good Samaritan officials confirmed as well.

"By avoiding blood transfusions, you are not introducing an immune suppresser into the patient's body," Friedman said. "That causes (shorter) lengths of stays in both intensive care immediately following an operation and in a regular hospital bed after that."

Patients of surgeons at Good Samaritan - which performed about 200 bloodless surgeries last year - have experienced a similar shortening of the recovery time, according to Dr. Manuel Estioko, director of the hospital's bloodless medicine and surgery center.

"There are simply fewer complications," said Estioko, who has been performing bloodless surgeries for about 10 years in California and New York.

Religious roots

No official statistics are kept on patients' reasons for choosing bloodless surgery, but Good Samaritan and OrNda hospital officials say about 20 percent of their bloodless surgery patients choose it for other than religious reasons. That is a considerable shift from a decade ago, when such procedures were performed almost exclusively on Jehovah's Witnesses, whose tenets forbid them from accepting transfusions.

"This is all borne out for fear of contracting infectious diseases, particularly hepatitis B," said Jim Lott, senior vice president of policy development and advocacy for the Healthcare Association of Southern California, a trade group that represents hospitals and physician networks. Loft himself underwent bloodless surgery a few years ago in San Diego.

"I would say there are two reasons for the expansion of bloodless medicine: fear of AIDS and hepatitis, and the chronic shortage of blood that many blood banks and Red Cross organizations experience," added Ed Susank, a Los Angeles-based principal with benefits consulting firm William M. Mercer Inc.

William D. Nicely, CEO of the Los Angeles American Red Cross Blood Services division, confirmed that during Christmas and New Year's the blood supply tends to run short, but he denied that there are any chronic shortages. Red Cross did raise local prices 6 percent last July, which means the average per-unit price in Los Angeles runs $98, among the costliest in the country. It recently conducted an aggressive recruiting drive to increase L.A.-area donors, which has added about 15 percent to the local supply.

And while Nicely observed that bloodless medicine has a negligible effect on Southern California's blood supply, he noted that "a conservative view (regarding transfusions) is appropriate. ... If you can perform surgery without having to utilize blood or blood product, the patient's risk would be reduced."