Refusing Blood Transfusions Lowers Risks of Surgical Complications?

"We have found that patients who undergo cardiac surgery and receive blood, there is an increased risk of complications such as longer time on the ventilator, increased risk of infection, damage to the heart. We also found those who received blood had a higher risk of morbidity, said Dr. Clement"

Gregory Pattakos, M.D., M.S., of the Cleveland Clinic, Ohio, and colleagues sought to compare morbidity and long-term survival rates of Jehovah's Witnesses undergoing cardiac surgery with a similarly matched group of patients who received blood transfusions.

The authors found that after propensity matching, Witnesses (322 patients) and non-Witnesses (322 patients) had similar risks for hospital mortality, but Witnesses had significantly lower occurrence of additional operation for bleeding, renal failure and sepsis compared with non-Witnesses who received transfusions.

"We also looked at those who did not receive blood and the effects of anemia, we found when you get very anemic, morbidity is just as high as is death, so we have two ends of the spectrum," said Dr. Clement.

Witnesses had fewer acute complications, including myocardial infarction (heart attack), additional operations for bleeding and prolonged ventilation. Witnesses also had shorter hospital stays compared with matched patients who received transfusions, as well as shorter intensive care unit stays.

Jehovah Witnesses take what Dr. Clement described as management strategies preoperatively to help prevent the anemia, such as use of iron and vitamin B.

 "It would require very careful study and examination before we can use these management strategies more broadly," added Dr. Clement.

"It is important we study this more because we have the aging baby boomers, they are going to need surgery, and older patients tend to be sicker, and tend to be more anemic, they need more blood than any other patient, Dr. Clement added.

The authors conclude that the Jehovah's Witness patients undergoing cardiac surgery at the Cleveland Clinic experienced similar or better short- and long-term survival than non-Witnesses. "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," they conclude.

SOURCE: JAMA, July 2012