Outcomes from cardiac surgery in Jehovah’s witness patients: experience over twenty-one years

Abstract

BackgroundCardiac surgery in Jehovah’s Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. The aim of this study was to document our center’s experience with Jehovah’s Witnesses undergoing major cardiac surgery and to compare surgical outcomes with a matched control group.MethodsWe retrospectively reviewed the demographic, perioperative, and in-hospital postoperative data for 31 Jehovah’s Witness patients undergoing surgery from 1991 to 2012 and compared findings with a control group of 62 patients of the same sex and age, who underwent the same type of operations in the same period. Early mortality, major in-hospital morbidity, laboratory findings, and hospital stays were compared between groups.ResultsDemographic data were similar between groups, except that more patients in the Jehovah’s Witness group had extracardiac arteriopathy compared with controls (p = 0.04). There was no difference in predicted mortality, calculated by the Euroscore II, between groups (2.8 ± 3.3 in study group versus 2.4 ± 2.2 in control group, p = 0.469). For postoperative outcomes, there were no differences between Jehovah’s Witnesses versus controls in hospital mortality (3 % versus 2 %, p = 0.548), total drain loss (847 ± 583 mL versus 812 ± 365 mL, p = 0.721), mechanical ventilation time (1.26 ± 2.24 versus 0.89 ± 0.55 days, p = 0.218), intensive care unit stay (4.3 ± 3.9 versus 3 ± 1.4 days, p = 0.080), and hospital stay (12.9 ± 7.6 versus 10.9 ± 6.6 days, p = 0.223).ConclusionsOutcomes after cardiac surgery are similar between Jehovah’s Witnesses and general population, in centers applying rigorous blood patient management protocols.

Implementing a protocol to optimize blood use in a cardiac surgery service: results of a pre‐post analysis and the impact of high‐volume blood users

“…The clinical experience in treating cardiac surgery patients who refuse blood products, namely, Jehovah's Witnesses, is perhaps one of the strongest indicators that a restrictive transfusion strategy can be implemented safely. Studies have shown that outcomes among patients who refuse blood products can be similar to low‐risk patients who accept blood products when appropriate perioperative measures are taken . Some centers treating Jehovah's Witness patients have focused exclusively on intraoperative blood saving techniques such as Cell Saver and meticulous closure techniques, while others also include measures such as the use of erythropoietin and iron supplements to treat preoperative anemia and limiting blood collection for routine laboratories .…”

“…Studies have shown that outcomes among patients who refuse blood products can be similar to low‐risk patients who accept blood products when appropriate perioperative measures are taken . Some centers treating Jehovah's Witness patients have focused exclusively on intraoperative blood saving techniques such as Cell Saver and meticulous closure techniques, while others also include measures such as the use of erythropoietin and iron supplements to treat preoperative anemia and limiting blood collection for routine laboratories . These studies are particularly useful indicators of the ability to safely limit transfusions after cardiac surgery as the Jehovah's Witnesses' strict refusal of any and all blood products prevents the crossover seen in some prospective, randomized trials.…”

Cardiac Surgery in Jehovah's Witness Patients: Experience of a Brazilian Tertiary Hospital

“…Previous retrospective studies demonstrated that cardiac surgery might be performed in JW with acceptable outcomes [ 2 - 10 ] . Furthermore, retrospective studies that compared mortality and morbidity rates in JW and controls showed leveled results between both groups [ 7 - 10 ] . Bhaskar et al.…”

“…More recently, the data of case series [ 2 - 6 ] and some controlled studies [ 7 - 10 ] showed that the perioperative and postoperative prognosis of JW is similar to those of patients who do not have restrictions to blood products transfusions. However, the rates of mortality and postoperative complications in patients that undergo cardiac surgery are variable.…”

Evaluation of postoperative clinical outcomes in Jehovah's Witness patients who receive prothrombin complex concentrate during cardiac surgery

“…The use of four-factor prothrombin complex concentrate (4PCC) to decrease bleeding related to coagulopathy is an alternative to alloBT and is generally acceptable among JW patients. 2 At present, several studies have evaluated the outcomes of patients who refuse blood products based on religious beliefs, [3][4][5][6][7][8][9][10][11][12] but little evidence has assessed the use of 4PCC in this population who undergo cardiac surgery. To our knowledge, this is the first retrospective cohort study evaluating postoperative clinical outcomes of JWs who underwent cardiac surgery that received 4PCC vs those who did not.…”