Blood transfusions were voted one of the most common unnecessary surgical procedures in a recent poll of anaesthetists. The evidence about when they are needed has changed but doctors can get stuck in their ways. So here's what you should know about blood transfusions – and some other medical procedures you may want to think twice about.
1. Don't let your doctor… give you blood (unnecessarily, that is)
Let's be clear, there is no doubt that blood transfusions save lives. But they have also been linked to higher death rates if they are given when not strictly necessary.
A study published this month looked at people taken to hospital with significant blood loss from physical injuries. For people judged on arrival to have more than a 50 per cent risk of dying, those who had a transfusion of red blood cells were twice as likely to survive as those given no transfusion. But in arrivals judged to have less than a 6 per cent chance of dying, those who got a transfusion were five times as likely to die as those who did not receive one.
It's not clear why but a dose of someone else's red stuff may mildly weaken the immune system or, more rarely, cause lung inflammation, says Lee Fleisher, an anaesthetist at the University of Pennsylvania in Philadelphia.
2. Don't let your doctor… operate on you on a Friday
Some people don't like Mondays, but it's a good day for an operation.
Emergency surgery should of course be carried out whenever doctors advise it, but if you face any non-urgent surgery and are offered a choice of day, keep in mind that the earlier in the week you have it, the better things are likely to end up.
People who have surgery on Fridays have a 44 per cent higher risk of death than those who go under the knife on Mondays, a study found last year.
Patients tend to get worse post-operative care at weekends because hospitals have fewer staff in, and those who are around tend to be more junior. "That first 48 hours is the most critical part of a patient's recovery from an operation," says Paul Aylin of Imperial College London, who carried out the study.
Aylin is quick to point out, however, that most kinds of non-urgent surgery have a low risk of death to begin with – often less than 1 per cent – so a 44 per cent increase is still a small risk in absolute terms. Still, when it's your life on the line, every little helps.
3. Don't let your doctor… approach you brandishing a razor
Hair is dirty – so if you're going to be cut open you'd think it would be the last thing you'd want waving around. Hence the long tradition of the pre-surgery shave for any hairy parts of the body. For some men, this can be nearly everywhere. Hair removal is often done with a disposable razor, sometimes without so much as a splash of water.
The trouble is that this approach causes the exact problem it is supposed to prevent – a wound infection. "The razor grazes the top layer of skin and you get tiny, microscopic cuts," says Judith Tanner, a professor of nursing at De Montfort University in Leicester, UK, who has reviewed the research on the subject. "Bacteria from your skin get in and multiply."
Official advice in the UK and the US is now that body hair should not be removed unless it will physically get in the way of surgery or dressings, in which case electric clippers should be used. But you still see cheap razors used, says Tanner. "It's dispiriting."
4. Don't let your doctor… give you a new hip – get an "old" one instead
When it comes to technology, newer is usually better. That's not necessarily true when it comes to medical devices. Unlike in the US, in Europe there is no requirement for new devices to undergo years of randomised controlled trials before they go on sale. They merely have to pass some basic safety tests.
There are over 200 different types of artificial hip available in the UK, with new designs introduced every year or so. It can take 15 years or so to see if a new model is as effective and long-lasting as existing ones. The most recent problem to come to light is with some metal hips, which can wear down too fast, releasing metal into the bloodstream.
Some people are too keen to try the newest technology, says Siôn Glyn-Jones, an orthopaedic surgeon at the Oxford University Hospitals in the UK. "They read about it in the Daily Mail. We spend most of our time saying 'No, it's too new'." Neither are surgeons immune to manufacturers' marketing spiels. "There's a need to keep innovating but there's a balance between that and safety," says Glyn-Jones.
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