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Using Perfusion, Surgeons See Wounds Heal Faster
YOUNGSTOWN, Ohio -- The natural healing capabilities of the human body can be astounding – even more so when medicine gives them a gentle nudge. One such nudge is perfusion.
The term “perfusion,” derived from the French verb perfuse, means “pouring over or through,” especially when applied to the passage of a fluid through the vessels of a specific organ.
The Certified Clinical Perfusionists (CCP) of Canfield-based Advanced Perfusion LLC offer their services to local health care providers such as St. Elizabeth Health Center as they operate the heart and lung machine during open-heart surgeries. However, co-owners Michael and Diane Rosteck and Ron Snyder say the company’s bread and butter is its platelet gel therapy.
Produced from a patient’s own blood, platelet gel is a mixture of the concentrated platelets and growth factors, such as white blood cells, and mixed with a platelet activator, such as Thrombin, Michael Rosteck says. After surgery, the platelet gel is sprayed on the tissue at the incision site before closing the wound. This helps to speed healing and minimize the risk of pain and infection.
“Just by using that platelet gel – growth factors and white blood cells – in the proper site, it causes less bleeding, less swelling, and the wounds heal much quicker and cleaner than they would otherwise,” Rosteck says.
While in the operating room or the pre-op room, the perfusion specialist draws 52 cc (cubic centimeters) of blood from the patient – not much when you consider 500 cc is equal to one pint. A spin in a specialized centrifuge separates the red blood cells from the white and the platelets, which are then transferred to a large syringe. From there, the white blood cells and platelets are mixed with the Thrombin.
Platelet gel has been around the last decade, but has increased in popularity among health care professionals in the last six years, Snyder says. Advanced Perfusion keeps office space at St. Elizabeth’s where it uses platelet gel in 70% to 80% of open-heart surgeries.
“We did a trial run here with the surgeons and they liked it, and we’ve been continuing ever since,” Snyder says. “It’s the patient’s own blood, so it has added benefits versus something that’s just off the shelf that doesn’t have the patient’s own biologics in it.”
At present, health insurers do not reimburse for the procedure, but the hospital’s cost isn’t passed onto the patient because it’s more cost-effective to use the patient’s own biologics than something off the shelf, Snyder says. In fact, because a hospital-acquired infection after surgery can be costly for a hospital, he says using the platelet gel can pay for itself.
“If you can prevent one infection of a patient for all the surgeries that you do in a year, you’ve paid for all the gel you’ll use that year,” Snyder explains.
Dr. Jeffrey Fulton, a cardiothoracic surgeon at St. Elizabeth Health Center, agrees with the cost- benefit analysis of platelet gel, but says some remain skeptical of its use.
“The risk of wound complications and infections in heart surgery without platelet gel is still low,” Fulton says, in the neighborhood of 2% to 3%, which is why some health care professionals argue it’s not worth the added cost.
“But, if you can take your wound infection rate and cut it in half, the prevention of one major wound infection is worth the cost over that percentage of patients,” Fulton says.
The bigger question, the surgeon says, is: Will platelet gel be used in more cases down the road?
Fulton uses platelet gel in about 30% of the surgeries he performs, reserving it for a special subset of patients – the elderly, diabetic, morbidly obese, and those undergoing long-involved cardiac operations.
“The patients that we don’t use it on are in the low-risk category for wound problems,” Fulton says. “As more and more people use it, the cost of the product can diminish and then the utilization may be a little bit more. The only drawback at this point is that we don’t have the data to support the increased wound risk and the cost of the process.”
Advanced Perfusion also performs bone marrow aspirate – a process similar to producing platelet gel – to help bone grow again after back surgery, says Rosteck.
Fusions are common in back surgeries, in which “they try to fuse the vertebrae together.”
For a bone marrow aspirate, the perfusionist takes marrow the surgeon draws from the hipbone and concentrates it in the centrifuge as he would with the blood for the platelet gel, “but now we’re concentrating down the bone marrow, which has your stem cells in it,” he says. The aspirate is used with the chips of bone from the spine.
“They will spray the bone marrow aspirate concentrate on the bone chips and they pack it together in the back,” Rosteck says. “And by having those stem cells there with the patient’s own bone chips, that will help the bone grow quicker, stronger and help it heal faster overall.”
Perfusionists say wound care is one of the areas that could benefit most from platelet gel, but unlike gel used in back and open-heart surgery, it isn’t reimbursed by Medicare, Rosteck says. With lower leg wounds, patients who are obese, diabetic, or have poor circulation could suffer from slow-healing wounds.
“Some patients go years with wounds on their lower extremities and they have to go once, twice a week to the doctor’s office to get them cleaned and re-dressed,” Rosteck says.
“We’ve seen platelet gel work on these wounds and heal these wounds. By us pulling the blood and concentrating down those growth factors, those platelets, we’re able to apply those to the wound where they need to be so they can work effectively and heal the wound quicker than the patient can do on their own.”
Despite the success some surgeons have with platelet gel, some question its efficacy. Their concerns are driven mostly by the difficulty of quantifying the benefits the gel.
Dr. Tom Boniface, an orthopedic surgeon with Boniface Orthopaedics Inc., Boardman, says while he’s seen surgical wounds heal faster with platelet gel, no hard and fast rate of improvement has been defined.
“These aren’t things that we can necessarily measure,” Boniface says. “It’s part of a continuum of improvement that we see. I can tell you this, if I’m having my knee replaced, I want that gel in there.”
Boniface admits he was skeptical at first about platelet gel when Advanced Perfusion’s Snyder showed him the data from heart surgeries and the rate of wound infections going down.
After using the product with his own patients for elective knee and hip replacement surgery, Boniface says the benefits of using platelet gel are evident in the healing of the post-surgical wounds.
“People would come back a week after surgery, and I’d look at their knee or their hip and I’d say, ‘This looks like it’s six weeks old,’ yet it’s only been 10 days,” he says. “To me, the visual evidence is compelling, and it made a believer out of me.”
On average, Boniface performs four to five elective knee and hip replacements per week, up to 150 a year, and uses platelet gel on all of them, much to his patients’ appreciation, he says.
Since he started using the gel produced by Advanced Perfusion five years ago, he’s watched his patients’ healing time, swelling and pain all decrease, he says. Boniface expects platelet gel will become used more widely.
“That’s going to require some standardization of product and standardization of application,” Boniface says. “We’ve got a lot of people using it here and there, but we’re not really bringing the data together well enough to convince the insurance companies to pay for it.”
To that end, Boniface says the health care community is working to collect enough data to release an “apples-to-apples comparison” of surgeries that use platelet gel and surgeries that don’t. A Web-based seminar will be held later this month, hosted by the American Academy of Orthopaedic surgeons, to discuss the use of platelet gel and platelet-rich plasma in orthopedic surgeries and weigh the benefits.
“We just think it makes sense to take the patient’s own natural healing elements and get them in there as quick as possible,” Boniface says. “There’s no downside to it whatsoever. The cost is minimal and the potential benefits are very high.”
Advanced Perfusion has offered its services to local health care providers since 2004. The company employs another certified perfusionist, Marit Aspenleiter, and two perfusion assistants, Angela Tankovich and Jason Latimer.
Copyright 2013 The Business Journal, Youngstown, Ohio.
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