‘Need accountability, assessment & auditing’

Padma Shri Dr Yash Gulati, senior orthopaedic surgeon, Indraprastha Apollo Hospitals, talks to Sangeeta Yadav about the new knee replacement surgery technique without the use of the risky tourniquet

What are the new methods of knee replacement without using tourniquet?

We do hip surgery, neck surgery and others without the tourniquet (tying a tight band around the part of the body to prevent the flow of blood to the surgery spot). So we decided to do the knee surgery with this method too. Till now, we have successfully done over 200 knee surgeries without or with limited use of the tourniquet. The post-operative management is easier and painless when the surgeries are conducted without using the tourniquet. Doctors should discuss with their patients the pros and cons of the scenario and accordingly, allow the patient the choice between a traditional and a modern approach.

Why is tourniquet ineffective?

It has a lot of disadvantages like the damage to the muscles and calcification in the blood vessels of the arm or the leg which can cause gangrene. When the blood flow is restored after taking the tourniquet off after surgery, there can be reactionary swelling. The metabolic products which get accumulated in that area bring out toxic materials like lactic acid which can circulate into the body and cause damage. Injury to the skin underneath can cause blisters, bleeding and possible ischemia beyond the area where the tourniquet was tied during the surgery. When we do surgery without the tourniquet, there are zero risks.

We have high medical expertise in cities. Why not rural areas?

There is one doctor for 1,700 patients. We are still ranked 112th in terms of healthcare that we provide to our citizen in rural areas. We have the centres of excellence yet our horizontal stretch is not across the country. The Government spends just 1.2 per cent GDP on healthcare which is expected to reach three per cent by 2022. The only option is a public-private partnership or encouraging private enterprise. But there has to be accountability, assessment and auditing.

What about the high cost of private healthcare?

Profitability should be reduced and we need to have a transparent system so that our patients know why they are being charged so much. Hospitals can’t charge three times of what the actual cost is even though there are high expenses on staff, infrastructure, private medicine etc.

Corporate hospitals are getting to earn five-10 per cent only, rest 50 per cent expenses goes on staff, 30 per cent on consumable and 15 per cent on infrastructure. We need to economise by having limited but efficient staff, turn paperless, reduce prices and profit margins, use cheaper equipment and conduct surgeries in a cost-effective manner.