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Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a
Nicole R Guinn1, Russell S Roberson2, William White1
1Department of Anesthesiology.
Insights
Cardiac surgery for Jehovah's Witness patients refusing blood transfusions shows similar costs and outcomes, including zero mortality, compared to patients receiving transfusions. Blood conservation strategies are key for successful outcomes in these select patients.
Area of Science:
- Cardiology
- Transfusion Medicine
- Health Economics
Background:
- Cardiac surgery is feasible for patients refusing blood transfusions.
- Limited research compares costs and outcomes between blood refusal patients and matched controls.
- Jehovah's Witness patients present a unique cohort for studying transfusion-independent cardiac surgery.
Purpose of the Study:
- To compare the costs and clinical outcomes of cardiac surgery in Jehovah's Witness patients who refuse blood transfusions versus matched controls who accept transfusions.
- To evaluate the economic impact and patient results of transfusion-free cardiac procedures.
- To assess the safety and efficacy of blood conservation techniques in cardiac surgery.
Main Methods:
- Historical cohort study design.
- Retrospective review of patients undergoing cardiac surgery from January 2005 to July 2012 at Duke University Medical Center.
- Matching 45 Jehovah's Witness patients (refusing blood products) 1:2 with controls (accepting transfusion) based on influencing characteristics.
- Analysis of costs (surgery to discharge), length of stay (LOS), discharge hemoglobin (Hb), and acute kidney injury.
Main Results:
- No significant difference in total cost between Jehovah's Witness patients and controls.
- Identical intensive care unit (ICU) length of stay (LOS) (median 1 day) and similar total LOS (9 days vs. 7 days).
- Higher mean discharge hemoglobin (Hb) in Jehovah's Witness patients (11.7 g/dL vs. 9.8 g/dL).
- Zero 30-day mortality in both groups.
Conclusions:
- Cardiac surgery can be performed with comparable costs and outcomes in select patients refusing blood transfusions, provided blood conservation measures are employed.
- Transfusion-free cardiac surgery is a viable option with excellent safety profiles.
- This study supports the use of advanced blood management techniques in specific patient populations.
Background:
Although numerous studies have demonstrated the feasibility of cardiac surgery for blood refusal patients, few studies match to controls, and fewer examine cost. This historical cohort study aims to compare costs and outcomes after cardiac surgery in Jehovah's Witness patients who refuse blood transfusion with a group of matched patients accepting transfusion.
Study Design And Methods:
A retrospective database review was performed to find all patients having cardiac surgery who refused blood products from January 2005 to July 2012 at Duke University Medical Center. These 45 patients were closely matched 1:2 with controls who accepted transfusion based on characteristics likely to influence transfusion. Cost from day of surgery to hospital discharge and other outcome data (length of stay [LOS], discharge hemoglobin [Hb], acute kidney injury) were analyzed retrospectively.
Results:
Forty-five Witnesses having cardiac surgery were temporally matched to two controls having the same surgery. Median euroSCORE was the same in both groups (6.0, p = 0.9981). In the matched-pairs comparison of cost, there was no significant difference in total cost for Witnesses and controls. There was no difference in intensive care unit LOS (median, 1 day, both groups) or total LOS (median, 9 days for Witnesses vs. 7 days for controls). Mean Hb at discharge was higher in Witnesses than in controls (11.7 g/dL vs. 9.8 g/dL, p < 0.001). Thirty-day mortality was zero in both groups.
Conclusion:
Utilizing applicable blood conservation measures, cardiac surgery may be performed with similar outcomes and cost from day of surgery to discharge compared to controls in select patients without blood transfusion.
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