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Blood Conservation Doesn't Impact Non-Cardiac Surgical Outcomes

Surgical Rounds®, December 2013,

Study concludes that patients refusing blood products should not be denied non-cardiac surgical treatment.

Patients have been known to refuse blood transfusions due to religious convictions, medical concerns, or personal preferences. To deny those blood conservation (BC) patients the option of non-blood medical care is to deny them access to treatments that the rest of the population takes for granted.

Though surgical centers across the country are observing BC programs using bloodless medical procedures, knowing more about the outcomes in those who refuse transfusions would aid in the decision process for physicians, patients, and their families.

Since little research on BC patient outcomes after non-cardiac surgery is available, Bala Ramanan, MBBS, and colleagues at Creighton University conducted a study that compared the surgical outcomes of 120 patients enrolled in a BC program to the outcomes of 238 conventional care (CC) patients. Both groups had similar operating times, length of hospital stays, surgical readmission rates, and preoperative conditions with the exception of smoking, which was lower in the BC group.

The bloodless surgery program examined in the study had a high level of success, which enabled the researchers to enroll an adequate number of BC patients. The authors claimed that discussing advance directives and obtaining informed consent are unique features of the BC program at their institution, as most hospitals do not have a dedicated program or protocol for BC patients. Once patients are identified as belonging to the BC program, their data and preferences are available for future hospitalizations. Blood loss in both the preoperative and postoperative periods is minimized by restricting laboratory draws to the minimum required and by using pediatric blood collection tubes. Postoperatively, surgeons monitor BC patients carefully and treat them promptly if hemorrhaging occurs.

After multivariable analysis, the researchers determined that outcomes in BC patients were similar to those in the CC group. Thus, the authors said that patients refusing blood products should not be denied surgical treatment.

While other benefits of BC programs have been observed, BC patients’ long-term surgical outcomes need to be evaluated by future studies. Nevertheless, recent literature has demonstrated higher mortality and morbidity in general surgery patients with even limited intraoperative transfusion, which supports the authors’ conservative approach to blood transfusion.