Asia-Pacific Biotech News

Why Bleeding Matters: The Risks of Surgical Bleeding and Importance of Effective Haemostasis

Associated with high mortality rates and an immense strain on healthcare resources, uncontrolled surgical bleeding can have adverse effects on both patients and hospitals. With its rising prevalence in Asia Pacific, it is imperative that healthcare systems in the region take immediate action to minimise bleeding and optimise patient outcomes.

by Professor Hiroshi Niinami

With up to 70% of open procedures experiencing disruptive bleeding events, the unfortunate reality is that increased surgical bleeding has become the norm.1 This is concerning because disruptive bleeding during procedures is strongly associated with high mortality rates, and can strain healthcare systems amid a global blood supply shortage.1 Furthermore, complications related to surgical bleeding can lengthen both operating time and hospital stay. Every additional minute in the operating room is estimated to cost approximately US$89, and each additional hospital night is around US$1,240.2 As a result, surgical bleeding can lead to a considerable increase in hospital-related costs.

To tackle this, healthcare professionals need a comprehensive understanding of the risk factors associated with surgical bleeding, as well as suitable haemostasis methods. This knowledge is imperative for systemic improvements in patient bleeding management.


Patient and Intraoperative Factors that Contribute to Surgical Bleeding

When it comes to cardiac surgeries, the risk of surgical bleeding is heightened by a mix of both patient and operative factors.

The Asia Pacific region is confronting a rapidly ageing population, currently representing around 60% of the world’s older persons population with over 630 million people aged 60 and above.3 The increased age of patients correlates with more complex and extensive surgeries, subsequently heightening the risk of surgical bleeding.4

With an increase in patient comorbidities such as uncontrolled diabetes and obesity, the natural blood clotting process can become complicated.5 Medications also play a significant role. The use of multiple medications, such as aspirin and non-steroidal anti-inflammatory medicine, can affect the likelihood of surgical bleeding.

Particularly worrisome is the use of anticoagulants and antiplatelets to treat cardiovascular disease. These can contribute to surgical bleeding, as up to 25% of such incidents result from acquired or congenital coagulopathy.6 Given the rising incidence of cardiovascular disease in the region, this further elevates the risk of bleeding complications.

However, patient demographics and health conditions represent only one side of the equation. Intraoperative factors can significantly increase the risk of disruptive bleeding during cardiac procedures. For example, surgeons navigating uneven tissue topography or sternal bone bleeding during a procedure may encounter an increased risk of surgical bleeding. Technical complexities such as obstructed visualisation by anatomical structures, and difficult-to-access bleeding sources can also complicate the control of disruptive bleeding.

This raises an important question: How can healthcare professionals manage these risk factors to effectively administer haemostasis for surgical bleeding?


The Importance of Adjunctive Haemostasis

Successful haemostasis is not a one-size-fits-all solution. Different types of bleeding require tailored methods of management, and conventional methods may not always be sufficient to achieve complete haemostasis. Conventional methods, like mechanical or other primary methods of haemostasis, come with their drawbacks. Depending on the specific procedure and intraoperative factors, these methods can be of limited use.

In instances where primary methods fall short, adjunctive topical haemostats can provide essential support for rapid and effective haemostasis. For example, while arterial bleeding through a large artery can often be managed with conventional methods alone, capillary and venous bleeding, which are characterised by slow flow, diffuse oozing, and dark red blood, may require a combination of both primary methods and adjunctive haemostats. From topical absorbable haemostats like oxidised regenerated cellulose to active haemostats such as fibrin sealants, these adjunctive measures are key in quickly and effectively managing bleeding.

The combination of conventional and adjunctive haemostasis methods has been linked to significant reductions in hospital resource use. Benefits include up to a four-day reduction in patients’ hospital stays, a 25-minute reduction in operating time, and a substantial decrease in the likelihood of hospital readmission.7 Significant cost savings have also been observed with the use of adjunctive haemostasis, with a 15% decrease in spend per haemostat and an estimated annual saving of US$168,688.9


Reducing the Risk of Blood Transfusions

Effective bleeding management is crucial not just for optimising patient outcomes and easing the strain on hospital resources, but also for reducing the incidence of inappropriate blood transfusions. The recent global health crisis, including the COVID-19 pandemic, has led to a critical shortage in the global blood supply and a call for decreased dependency on blood transfusions. Blood transfusions are among the top five most overused medical procedures, with research indicating that up to 60% may be considered inappropriate – revealing a need for healthcare professionals worldwide to escalate their efforts to preserve patients’ own blood.8

The optimal use of haemostats is a significant step in this direction. Particularly, the use of adjunctive haemostats has been shown to reduce the risk of blood transfusions by up to 35%.9


Patient Blood Management Programs

The first and most fundamental step to implementing significant improvements to patient bleeding management is ensuring that surgeons are well-educated on the optimal haemostasis methods for different types of surgical bleeding.

Patient blood management programs can offer a systematic approach to keeping surgeons well-informed by establishing a more standardised approach to optimise haemostasis approaches across healthcare systems.

Research shows that surgeons are most likely to consider the site and the situation as primary factors when confronted with a surgical bleeding incidence and choosing which adjunctive haemostat to use. Patient blood management programs which leverage these considerations to offer healthcare professionals holistic support in better responding to surgical bleeding have been proven to reduce surgical variation, maximise efficiency and improve patient and clinical outcomes.10

By delving into the complexities of risk factors and exploring the broad range of adjunctive haemostasis methods and solutions available, healthcare professionals can be better equipped to optimise patient care across the Asia Pacific region. It is not just about understanding why bleeding matters, but also about taking thoughtful, appropriate actions in response to the importance of effective bleeding management. Together, we can boost patient safety, reduce the burden on hospitals, and foster a healthcare environment that is both sustainable and compassionate. [APBN]

This article was first published in the September & December 2023 print version of Asia-Pacific Biotech News.

About the Author

Professor Hiroshi Niinami, Cardiovascular Surgeon, Department of Cardiovascular Surgery, Tokyo Women’s Medical University Hospital

As a leading Japanese cardiovascular surgeon, Professor Niinami is an expert in the fields of surgical haemostasis and bleeding management.