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Transfusion refusal after cardiac surgery failed to reduce survival
Results from a new study suggest that Jehovah’s Witness patients who undergo cardiac surgery are not at increased risk for surgical complications or death when compared with patients who undergo surgery and receive blood transfusions.
Gregory Pattakos, MD, MPH, of the Cleveland Clinic, and colleagues published data in Archives of Internal Medicine comparing morbidity and long-term survival rates of Jehovah’s Witness patients undergoing cardiac surgery (n=322) with a similarly matched group of patients who received blood transfusions (n=48,986). All patients underwent cardiac surgery at the Cleveland Clinic from 1983 to 2010.
Jehovah’s Witness patients hold beliefs that disallow blood product transfusion and encourage the use of a number of blood conservation practices, according to background information in the study.
Compared with patients who received blood transfusions, Jehovah’s Witness patients had significantly lower occurrences of additional operation for bleeding (3.7% vs. 7.1%; P=.03), MI (0.31% vs. 2.8%; P=.01) and prolonged ventilation (6% vs. 16%; P<.001), as well as renal failure and sepsis. Patients who refused transfusions also had a shorter length of stay in the hospital and in the ICU.
In addition, Jehovah’s Witness patients had higher survival rates compared with non-Witnesses at 1 year (95% vs. 89%), but both groups had similar survival rates at 20 years (34% vs. 32%), according to a press release.
Pattakos and colleagues concluded that the patients who did not receive transfusions experienced similar or better short- and long-term survival than patients who received transfusions.
“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 researchers concluded.
In an invited commentary, Victor A. Ferraris, MD, PhD, of the University of Kentucky, Chandler Medical Center, said these findings “[raise] questions about whether more patients might benefit from surgical strategies that minimize transfusion of blood products.”
For more information:
Ferraris VA. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.2458.
Pattakos G. Arch Intern Med. 2012;doi:10.1001/archinternmed.2012.2449.
Disclosure: Drs. Ferraris and Pattakos report no relevant financial disclosures.