Abstract
Background Jehovah’s Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions.
Methods A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non-Witnesses, 38 467 did not receive blood transfusions and 48 986 did. We used propensity methods to match patient groups and parametric multiphase hazard methods to assess long-term survival. Our main outcome measures were postoperative morbidity complications, in-hospital mortality, and long-term survival.
Results Witnesses had fewer acute complications and shorter length of stay than matched patients who received transfusions: myocardial infarction, 0.31% vs 2.8% (P = . 01); additional operation for bleeding, 3.7% vs 7.1% (P = . 03); prolonged ventilation, 6% vs 16% (P < .="" 001);="" intensive="" care="" unit="" length="" of="" stay="" (15th,="" 50th,="" and="" 85th="" percentiles),="" 24,="" 25,="" and="" 72="" vs="" 24,="" 48,="" and="" 162="" hours="" (p="" />< .="" 001);="" and="" hospital="" length="" of="" stay="" (15th,="" 50th,="" and="" 85th="" percentiles),="" 5,="" 7,="" and="" 11="" vs="" 6,="" 8,="" and="" 16="" days="" (p="" />< .="" 001).="" witnesses="" had="" better="" 1-year="" survival="" (95%;="" 95%="" ci,="" 93%-96%;="" vs="" 89%;="" 95%="" ci,="" 87%-90%;="" p="." 007)="" but="" similar="" 20-year="" survival="" (34%;="" 95%="" ci,="" 31%-38%;="" vs="" 32%="" 95%="" ci,="" 28%-35%;="" p="." />
Conclusions Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.