Chennai, Aug. 3: Banana farmer Ratina Vadivoo underwent a triple bypass surgery at a city hospital last week. A few hours after the complex operation, Vadivoo was sitting up in his bed and drinking his soup, he walked to the bathroom on the following day, and four days after the surgery, his doctors bade him farewell as he went home. Vadivoo underwent a ‘fast track’ bypass surgery, one of the many procedures that are now done the fast track way in order to cut costs, reduce hospitalisation and minimise chances of the patient catching hospital acquired infection.
Taking a cue from the UK National Health Services, private hospitals are increasingly opting for ‘fast track’ surgeries, and even day care surgeries for simple procedures performed under local anesthesia.
“The advancements in anaesthesia now enable us to provide patients with ‘ambulatory anaesthetics’. With these short-acting drugs, the patient gains consciousness as soon as the surgery is over and does not even feel drowsy,” says Dr K Nedumaran, cardiac anaesthesiologist and intensivists at the Billroth hospital here.
Apart from facilitating an early psychological and physiological recovery for the patient, fast track surgeries bring down bed occupancy rates at hospitals.
“Consequently, the hospital can perform more procedures, admit more patients and thus reduce the cost of the procedures as well as waiting time for patients,” explains Dr Nedumaran.
Says Dr S.H. Jaheer Hussain, an orthopaedic and trauma surgeon with a 4-year work experience in the UK, and where there are large hospitals dedicated only to day care procedures,
“The concept is slowly picking up, but the hospital needs a highly competent medical team to successfully pull off day care surgeries. A total knee replacement case can be discharged in three days by a dedicated team, when the traditional surgery requires 7 to 10 days’ hospitalisation.” fast track surgery, if adopted, bypasses several constraints that are now associated with hospitalisation and would prove a big boon to patients.
By Express News Service (19 Mar 2009 02:40:00 AM IST)
Fast track cardiac operations in Chennai
CHENNAI: With the support of advanced technology, high precision drugs and intensive patient monitoring, a city hospital is successfully performing ‘Fast Track Cardiac Surgeries’ and discharging patients in a span of five days.
Doctors at Billroth Hospitals, who have been performing this fast track surgery, which allows patient to be on their feet within four days after a cardiac surgery, claim 99 per cent success. In the last two and a half years, the hospital has done around 500 such surgeries, “said Dr K Nedumaran, cardiac anesthesiologist and intensivist, Billroth Hospital.
In this system, the patient will be shifted to the ICU immediately after the surgery and a doctor who had performed the surgery will be there to take care of the patient at the ICU also. “Hence, there is continuity. There is no requirement of a new team at the ICU to pick up the details of the surgery and proceed as the doctor can guide them,” he added.
The next day, the patient will be moved to the ward, where he can take juice and other food prescribed by the doctor. On the third day, he will be asked to walk around and climb the stairs. The next day, an observation will be done to find out how the patient responds and on the fifth day he will be asked to take a bath and the doctors will check the wound.
Patients who have undergone this surgery are also happy. “Initially I was scared. But it got over in five days,” said a much relaxed Marzook. Another patient Sundararajan said that the cost of surgery was very less. Dr Nedumaran said that the surgery, as a package of seven days, costs Rs 1.15 lakh.
Bloodless coup in heart invasion
Cardiothoracic division of Billroth Hospitals, which had performed over 500 heart surgeries successfully, has created a revolution in bloodless surgery by replacing the aortic valve and conducted coronary artery bypass on a 72-year-old male patient.
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The patient Thirumalachary, a member of the orthodox Christian group called Jehovah’s Witnesses that normally does not accept blood transfusion owing to their religious belief, underwent the surgery in the hospital located at Shenoy Nagar in Chennai.
Chief surgeon Dr S Thiaga-rajamurthy and his team comprising cardiologist Dr K Damo-daran, Dr U Ilayaraja, cardiac anesthetists Dr R Mahadevan and Dr K Nedumaran performed the surgery successfully without transfusion of blood.
Addressing the press Wednesday, the patient said the coronary artery bypass surgery was done on a beating heart before his circulation was taken over by the heart- lung machine so that the time on the machine and the period of cardiac arrest was minimised.
After the heart is stopped, the aorta which is the main blood carrying tube was opened. Valve was then excised. Sutures were placed all around and a tissue valve was placed and tied up.
All the sutures were placed carefully so that there was absolutely no bleeding whatsoever, since the patient absolutely had no second chance. Blood loss had to be minimised to the maximum.
In bloodless heart surgery, pre-operation drug erythropoietin is administered; acute normovolemic hemodilution has to carried out, hemo filter has to be placed and tranexamic acid infusion and loading dose under monitor had to be given. These are pre- requisites.
In this patient, the total loss for 24 hours after surgery was just 200 ml from the drainage tubes. Patient was mobilised after 48 hours. Meticulous planning, precision had to be adhered to in this case with hemoglobin level boosted upto 12 gram; post- operation, it was 9 gram and now it is 10.5 gram.
Patient’s sentiment in the matter of religion and faith apart, medically blood transfusion involves certain risks like HIV, hepatitis B etc blood- borne diseases creeping in and those had to be prevented. For these viruses for which there is no proper screening available, however with the advancement in medical science, bloodless surgeries are recommended.
Route to bypass is much easier now
Chennai, March 18: A coronary artery bypass surgery is no longer a long drawn out ordeal, with the popularisation of ‘fast-track’ bypass surgeries on offer in the city.
A combination of pre-operative breathing exercises, intra-operative techniques and careful post-operative monitoring, a fast-track bypass surgery claims to have the patient sitting up and eating in two hours after the surgery and walking out of the hospital within four days, minimising risk of infections and hospitalisation costs.
Take the case of a 55-year old police constable who underwent a bypass surgery on Saturday at the Billroth hospital, which specialises in fast-track procedures. “This patient needed four grafts.
We harvested veins from both his legs and his chest, for the surgery,” said Dr S. Thiagarajamurthy, chief cardio-thoracic surgeon at the hospital.
“He sat up and had soup the same evening and was shifted out of the ICU in less than 24 hours. He is ready to be discharged this evening,” Dr Thiagarajamurthy said on Wednesday.
Nearly all bypass surgeries at the hospital, irrespective of the patient’s age or co-morbidities like diabetes and hypertension, are now done as fast-track procedures.
“While conventional bypass surgery is done on an arrested heart, using a heart-lung machine to carry on blood circulation, this procedure is done on a beating heart. This way, the patient can recover sooner as the body does not have to go through the major physiological change of having his heart stopped,” cardiac anesthetist Dr K. Nedumaran said. ‘Ultra-short acting’ anesthetic drugs bring in the ‘fast-track’ aspect of the beating heart surgery, with the patient regaining consciousness in 2 hours.
Round-the-clock monitoring of the patient’s breathing and cardiac output and intensive post-operative care for four days completes the process that has a 15 to 20 per cent cost advantage over the conventional bypass, which requires hospitalisation for at least 10 days.
A team of cardiac surgeons at the Billroth Hospitals successfully performed a ‘bloodless heart surgery’ on a patient, who refused to accept blood transfusion, as it was against his religious belief.
A Coronary Artery Bypass Surgery without blood transfusion? Strange, but true. Doctors at a city hospital performed a CABG and valve replacement surgery on a 75-year-old male, stopping short of giving him a blood transfusion in deference to his religious wishes.
75-yr-old lives through bloodless open heart surgery
When 75-year-old Thirumalachari was diagnosed with valve problems and blocks in the heart vessels three weeks ago, doctors knew they had a tough job at hand. Not because his condition was complicated or the patient was a septuagenarian. The patient belonged to a community Jehovah’s Witness which did not allow him to accept blood transfusion, even from his own body.
75-yr-old lives through bloodless open heart surgery
When 75-year-old Thirumalachari was diagnosed with valve problems and blocks in the heart vessels three weeks ago, doctors knew they had a tough job at hand. Not because his condition was complicated or the patient was a septuagenarian. The patient belonged to a community Jehovah’s Witness which did not allow him to accept blood transfusion, even from his own body.
