Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case‐matched study

Abstract

BACKGROUND Although numerous studies have demonstrated the feasibility of cardiac surgery for blood refusal patients, few studies match to controls, and fewer examine cost. This historical cohort study aims to compare costs and outcomes after cardiac surgery in Jehovah's Witness patients who refuse blood transfusion with a group of matched patients accepting transfusion. STUDY DESIGN AND METHODS A retrospective database review was performed to find all patients having cardiac surgery who refused blood products from January 2005 to July 2012 at Duke University Medical Center. These 45 patients were closely matched 1:2 with controls who accepted transfusion based on characteristics likely to influence transfusion. Cost from day of surgery to hospital discharge and other outcome data (length of stay [LOS], discharge hemoglobin [Hb], acute kidney injury) were analyzed retrospectively. RESULTS Forty‐five Witnesses having cardiac surgery were temporally matched to two controls having the same surgery. Median euroSCORE was the same in both groups (6.0, p = 0.9981). In the matched‐pairs comparison of cost, there was no significant difference in total cost for Witnesses and controls. There was no difference in intensive care unit LOS (median, 1 day, both groups) or total LOS (median, 9 days for Witnesses vs. 7 days for controls). Mean Hb at discharge was higher in Witnesses than in controls (11.7 g/dL vs. 9.8 g/dL, p < 0.001). Thirty‐day mortality was zero in both groups. CONCLUSION Utilizing applicable blood conservation measures, cardiac surgery may be performed with similar outcomes and cost from day of surgery to discharge compared to controls in select patients without blood transfusion.

Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta‐analysis of comparative studies

“…Six studies reporting on 564 JWs and 903 control patients not refusing blood transfusion who underwent adult cardiac surgery fulfilled the inclusion criteria of this study and were the subjects of this analysis . The main characteristics of these studies are summarized in Table .…”

“…Six studies reporting on 564 JWs and 903 control patients not refusing blood transfusion who underwent adult cardiac surgery fulfilled the inclusion criteria of this study and were the subjects of this analysis. [10][11][12][13][14][15] The main characteristics of these studies are summarized in Table 1. Details on quality of the included studies are summarized in Table S1 (available as supporting information in the online version of this paper).…”

“…Remarkably, perioperative optimization of Hb levels might be an important issue in cardiac surgery as preoperative anemia is reported in nearly 30% of the patients in this surgical setting and those with iron deficiency may have a double chance of being transfused . An important limitation of the Hb optimization policy is that it is time‐consuming and the time from hospital admission to surgery may be longer for JWs than for controls . This delay seems not to increase costs, but it might be nonetheless not feasible in urgent and emergent cases …”

“…An important limitation of the Hb optimization policy is that it is time‐consuming and the time from hospital admission to surgery may be longer for JWs than for controls . This delay seems not to increase costs, but it might be nonetheless not feasible in urgent and emergent cases …”

Bloodless cardiac surgery: a strategy for few or the future standard of care?

“…In this issue of TRANSFUSION, Guinn and colleagues address the cost of providing bloodless cardiovascular surgery, which until now has been an unevaluated question in this specific patient population. The study employs cost data from multiple expense categories derived from an institutional accounting system, and the authors analyze in a case‐matched study the cost of bloodless cardiovascular surgery compared to that of standard care.…”