Refusal of Transfusions for Cardiac Surgery Was Not Associated with Shorter Long-Term Survival
QUESTION Is prospectively refusing blood transfusions after cardiac surgery associated with decreased survival or increased morbidity? METHODS DESIGN A propensity score-matched cohort study. SETTING Cleveland Clinic, Cleveland, Ohio, USA. PATIENTS 87 775 adults who had cardiac surgery between 1983 and 2010; available blood transfusion information; and for Jehovah’s Witnesses, preoperative documentation of refusal of red blood cells, platelets, plasma, and cryoprecipitate. Exclusion criteria were placement of ventricular assist devices, heart transplantation, and need for extracorporeal membrane oxygenation. 322 patients (mean age 62 y, 58% men) were Jehovah’s Witnesses who prospectively refused blood transfusions, and 322 (mean age 61 y, 58% men) were non-Witnesses who had blood transfusions and were matched with Witnesses on demographic variables, cardiovascular symptoms, comorbid conditions, valve pathology, coronary anatomy, and procedure and support variables. Results for the unmatched non-Witnesses who did (n = 48 664) or did not (n = 38 467) have blood transfusions are not reported in this abstract. RISK FACTORS Prospective refusal of blood transfusions. OUTCOMES Included in-hospital mortality, long-term survival, and lengths of hospital and intensive care unit (ICU) stays. All outcomes were obtained from a prospective registry database. MAIN RESULTS Propensity-matched analyses showed that patients who prospectively refused blood transfusions had shorter ICU (median 25 vs 48 h, P < 0.001) and hospital (median 7.1 vs 8.0 d, P < 0.001) stays and improved 1-year survival (95% vs 89%, P = 0.007) compared with those who had transfusions. Refusing blood transfusions was not associated with improved survival at 20 years (34% vs 32%, P = 0.90) or reduced in-hospital mortality (3.1% vs 4.3%, P = 0.40). CONCLUSION In patients having cardiac surgery, prospectively refusing blood transfusions was associated with shorter hospital stays and improved short-term but not long-term survival compared with having transfusions.
