title: Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Guinn
authors.affiliation: Department of Anesthesiology, UT Southwestern, Dallas, Texas.
authors.forename: Russell S
authors.initials: RS
authors.lastname: Roberson
authors.affiliation: Department of Anesthesiology.
authors.forename: William
authors.initials: W
authors.lastname: White
authors.affiliation: Duke Clinical Research Institute.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cowper
authors.affiliation: Department of Anesthesiology.
authors.forename: Bob
authors.initials: B
authors.lastname: Broomer
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Milano
authors.affiliation: Department of Anesthesiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiricolo
authors.affiliation: Department of Anesthesiology, UT Southwestern, Dallas, Texas.
authors.forename: Steven
authors.initials: S
authors.lastname: Hill
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000191:economics*; D016022:Case-Control Studies; D004921:Erythropoietin / Q000627:therapeutic use; D017048:Health Care Costs; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D033221:Jehovah's Witnesses; D007902:Length of Stay; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin