Today we will be discussing cardiac surgery patients who refuse transfusions, such as Jehovah’s Witnesses. Although the transfusion rate varies between 25% to 100% among cardiac surgery patients, cardiac surgeries without transfusions have been feasible for decades. Studies have even demonstrated improved outcomes in surgeries without transfusions.
Dr. Guinn describes the standard treatment course for Jehovah’s Witness cardiac surgery patients.
“Unlike other patients, Jehovah’s Witness patients are optimized preoperatively by treating anemia with erythropoietin and iron, and they receive a variety of perioperative blood conservation interventions to prevent and treat coagulopathy and limited phlebotomy.”
The costs of surgeries without transfusions, however, has been unknown. A recent study in TRANSFUSION led by Dr. Guinn examined the costs associated with 45 cardiac surgery patients who refused transfusions and retrospectively matched them with 90 patients who received standard care.
Dr. Guinn explains the primary findings of the study:
“We found no difference in total cost for hospitalization from day of surgery to discharge. Furthermore, although total hospital length of stay was not different between the 2 groups, blood refusal patients had a significantly shorter time from day of surgery to discharge, reflecting that the increased time needed to optimize patients prior to surgery is balanced by a faster postoperative recovery.”
In addition, length of ICU stay and mortality were also similar, and the mean hemoglobin at discharge was significantly higher in the Jehovah’s Witnesses. Therefore, blood conservation techniques and preoperative care can lead to similar surgery outcomes without increasing the cost of surgery.
Here is Dr. Bracey, who wrote an editorial on the subject:
“This study shows that the principles of patient blood management can be applied in a cost effective manner and in a safe manner for a broader population of patients. I think we need to look at moving towards a stance where transfusion which is often employed as a crutch is deemed an outlier.”
We’ll be back with another edition of Transfusion News on January 15th. Thanks for joining us.
- Guinn NR, Roberson RS, White W, Cowper PA, Broomer B, Milano C, Chiricolo A, Hill S. Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study. Transfusion 2015;55: 2791–2798..
- Bracey, A. Bloodless cardiac surgery: A strategy for few or the future standard of care? Transfusion 2015; 55: 2773–2774.