Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study

Abstract

Jehovah’s Witnesses (JWs) refuse allogeneic blood transfusions based on their religious beliefs. Anesthesiologists apply perioperative blood conservation strategies (BCSs) in patients who refuse allogeneic blood transfusions to prevent significant anemia or bleeding and avoid the need for transfusion. Therefore, we aimed to evaluate whether JW patients could safely undergo various surgeries that have a risk of bleeding without allogeneic transfusion, and compared their outcomes to those of patients allowing blood transfusion. We retrospectively collected data from 59 JW patients (JW group) and 362 non-JW patients (non-JW group) from January 1, 2010 to July 30, 2020. We defined surgeries with a risk of bleeding as open abdominal surgery, open gynecologic surgery, open hip surgery, open knee surgery, and spinal surgery. The primary endpoint was the mortality rate, and the secondary endpoints were the frequency of BCS application and postoperative morbidity. The mortality rate was 0% in the JW group and 3% in the non-JW group (p=0.370). The application of BCS was not significantly different between the groups (p=0.071). Postoperative infection occurred in 8.4% of the non-JW group and in none in the JW group (p=0.013); similarly, the incidence of disseminated intravascular coagulation was higher in the non-JW group (16%) compared to the JW group (3.4%) (p=0.008). JW patients can safely undergo surgeries that have a risk of bleeding without significant mortality and perioperative complications, with comparable outcomes to patients who received blood transfusion.