Patients who refuse transfusions after cardiac surgery fare better
Gregory Pattakos, MD, MS, of the Cleveland Clinic in Ohio, and colleagues set out to compare the complication and long-term death rate of Jehovah Witness patients who underwent cardiac surgery to better understand whether these patients put themselves at an increased risk if they refuse blood transfusions due to their beliefs.
"Although prior investigators compared immediate postoperative outcomes between Witnesses and non-Witnesses, comparisons of long-term survival are lacking," according to the article background. "Comparison is hampered, however, by impossibility of randomization to religious preference or blood transfusion, typical of any natural experiment."
Between Jan 1, 1983, and Jan. 1, 2011, a total of 322 Witnesses and 87,453 non-Witnesses underwent cardiac surgery at Cleveland Clinic. Among non-Witnesses, 38,467 did not receive blood transfusions and 48,986 did.
The authors used propensity matching to identify 322 Jehovah Witness patients who refused blood transfusion post-cardiac surgery and 322 patients who underwent cardiac surgery and received blood transfusions.
Similar risks for hospital mortality between the two groups were reported; however, Jehovah Witnesses had lower rates of additional operations for bleeding, renal failure and sepsis compared with those who received blood transfusion after surgery. The two groups had similar rates of in-hospital mortality, stroke, atrial fibrillation and renal failure.
Additionally, the authors reported that Witnesses had lower rates of MI, complications and additional bleeding operations. They also had shorter hospital length of stay and ICU length of stay compared with those who received blood transfusions.
Lastly, the authors reported that those who refused blood transfusion had higher rates of survival at one-year compared with those who underwent the treatment, 95 percent vs. 89 percent, respectively.
“Although we found differences in complications among Witnesses and control groups that received transfusions, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival,” the authors wrote.
"It is important to examine care of a patient population managed differently not only out of concern for morbidity risk but also for possible adoption of management strategies that may benefit other patient groups," the authors summed.
In an accompanying editorial, Victor A. Ferraris, MD, PhD, of the University of Kentucky Chandler Medical Center in Lexington, wrote, “[T]he finding that the Witnesses, who did not receive transfusions did at least as well as, if not better than, those who received a transfusion raises questions about whether more patients might benefit from surgical strategies that minimize transfusion of blood products.
“The findings of this analysis by Pattakos and colleagues add to the increasing data that suggest that more conservative use of blood transfusions would be in our patients’ interest, in both Witnesses and non-Witnesses,” he concluded.