BLOOD transfusions were recently voted one of the most common unnecessary surgical procedures in a . Evidence about when they are needed has evolved but doctors can get stuck in their ways. Here鈥檚 what you should know about transfusions 鈥� and other interventions you may want to think twice about.
Unneeded blood transfusions
There鈥檚 no doubt blood transfusions save lives. But they are also linked to higher death rates when given unnecessarily. A study published this month looked at people with significant blood loss from physical injuries. Of people judged on arrival at hospital to have more than a 50 per cent chance 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 (). A dose of somebody else鈥檚 blood may weaken the immune system, says at the University of Pennsylvania in Philadelphia.
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Friday operations
(BMJ, ). Patients tend to receive poorer post-operative care at weekends as hospitals have fewer staff in, and those present tend to be junior. Most non-urgent surgery has a very low risk of death in the first place, though, so the risk is still small in absolute terms, says of Imperial College London.
Pre-op shave
Hair is dirty, hence the pre-surgery shave for hairy parts of the body. This is often done with a disposable razor, sometimes with no water. Trouble is, this causes the exact problem it is supposed to prevent 鈥� a wound infection, says at De Montfort University in Leicester, UK. 鈥淏acteria from your skin get into tiny cuts and multiply.鈥� Official advice in the UK and US is now that hair should not be removed for hygiene reasons unless it will get in the way, and then electric clippers should be used. But you still see cheap razors, says Tanner.
Newer hip replacements
In the European Union medical devices don鈥檛 have to undergo years of randomised controlled trials before they go on sale, as they do in the US. For example, there are over 200 types of artificial hip available in the UK, with new designs appearing often. It takes time to discover if a new model is as effective as existing ones. The most recent problem is with . The answer? Don鈥檛 be a guinea pig 鈥� request a tried-and-tested design.
General check-ups
Health check-ups have long been popular in the US. They have recently been introduced in the UK as a 鈥渕idlife MOT鈥� to be done every five years. They sound like common sense but check-ups are surprisingly controversial, because they look for illness in people who have no symptoms. This can lead to unnecessary worry and treatment.
The most recent trial into the effectiveness of general check-ups looked at nearly 60,000 Danish people offered annual checks for five years. Five years after this period, (BMJ, ).
Futile resuscitation
Doctors get a for placing seemingly inappropriate 鈥渄o not resuscitate鈥� orders on patients鈥� notes. In fact, it鈥檚 more common for them to make the opposite mistake.
CPR can be life-saving in people who have a sudden cardiac arrest, but the violent procedure is also used in people who are dying as a result of long-term processes, whose chances of survival are close to zero. You can preempt matters by making an if you don鈥檛 want such extreme measures taken in the last moments of your life.
This article appeared in print under the headline 鈥淣ot what the doctor ordered鈥�