Outcomes from cardiac surgery in Jehovah's witness patients: experience over twenty-one years.

Sotirios Marinakis,Philippe Van Der Linden,Redente Tortora,Pierre Wauthy,Charalampos Pierrakos,Jacques Massaut

doi:10.1186/s13019-016-0455-6

Sotirios Marinakis, Philippe Van Der Linden + Show 4 more

Open Access

https://doi.org/10.1186/s13019-016-0455-6

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Abstract

BackgroundCardiac surgery in Jehovah’s Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. The aim of this study was to document our center’s experience with Jehovah’s Witnesses undergoing major cardiac surgery and to compare surgical outcomes with a matched control group.MethodsWe retrospectively reviewed the demographic, perioperative, and in-hospital postoperative data for 31 Jehovah’s Witness patients undergoing surgery from 1991 to 2012 and compared findings with a control group of 62 patients of the same sex and age, who underwent the same type of operations in the same period. Early mortality, major in-hospital morbidity, laboratory findings, and hospital stays were compared between groups.ResultsDemographic data were similar between groups, except that more patients in the Jehovah’s Witness group had extracardiac arteriopathy compared with controls (p = 0.04). There was no difference in predicted mortality, calculated by the Euroscore II, between groups (2.8 ± 3.3 in study group versus 2.4 ± 2.2 in control group, p = 0.469). For postoperative outcomes, there were no differences between Jehovah’s Witnesses versus controls in hospital mortality (3 % versus 2 %, p = 0.548), total drain loss (847 ± 583 mL versus 812 ± 365 mL, p = 0.721), mechanical ventilation time (1.26 ± 2.24 versus 0.89 ± 0.55 days, p = 0.218), intensive care unit stay (4.3 ± 3.9 versus 3 ± 1.4 days, p = 0.080), and hospital stay (12.9 ± 7.6 versus 10.9 ± 6.6 days, p = 0.223).ConclusionsOutcomes after cardiac surgery are similar between Jehovah’s Witnesses and general population, in centers applying rigorous blood patient management protocols.

Highlights

Cardiac surgery in Jehovah’s Witnesses may be challenging during the operation and postoperative period given their refusal of blood products
The control group was selected based on the type of surgical procedure as described in the methods (Table 2)
In the current study we presented the outcomes after cardiac surgery for a non-selected group of Jehovah’s Witnesses (n = 31) operated in our cardiac surgery department from 1991 to 2012

Summary

Introduction

Cardiac surgery in Jehovah’s Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. Jehovah’s Witnesses refuse the transfusion of blood products, based on Biblical passages citing to “abstain from food polluted by idols, from sexual immorality, from the meat of strangled animals and from blood” (Acts 15:19–20) Before major surgery, these patients are confronted with the stress of both the operation and the potential need for transfusion. The deleterious effects of blood transfusions in terms of postoperative morbidity and long term mortality after cardiac surgery, along with the cost and shortage of available blood products, suggest tighter transfusion protocols [1, 2, 8–11] In this context, the investigation of surgical outcomes in Jehovah’s Witnesses helps to evaluate the limits of transfusion safety and cut off points for transfusion, while improving the hospital care of this challenging group of patients [12]. The aim of this study was to document our center’s experience with complex cardiac surgery, including reoperations and urgent operations, in a non-selected Jehovah’s Witness group and to compare surgical outcomes with a matched control group

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