Page 43 - ANZCP Gazette APRIL 2022

8
Perfusion 00(0)
Transfusion in low-risk patients has been associated with an 8- to 10-fold increase in adverse outcomes21 and has been associated with AKI in cardiac surgical patients.22,23 We found reduced AKI in patients refusing transfusion and no difference in morbidity or mortality. Furthermore, a recent publication found no additional cost associated with refusal of transfusion in cardiac surgery.10 A management strategy plan in a recent review of perioperative JWs2 refusing blood transfusion bears very close resemblance to current published guidelines on blood management for all cardiac surgical patients24,25 and raises the question that treatment of patients who refuse transfusion may constitute a stand- ard of care for low-risk cardiac surgery.
This study provides the first analysis of real-time electronic data of the modifiable factors of CPB from a large registry in cardiac surgery patients refusing blood products. A more targeted manipulation of perfusion parameters for patients refusing transfusion whose oxygen carrying capacity may be constrained is now possible.
Limitations of this study include its retrospective observational nature and the small number of patients who refuse blood products within the registry popula- tion, making our study underpowered to determine dif- ferences in clinical outcomes other than any AKI (post hoc power was calculated as 86% for any AKI). Since the groups were matched within each time period, where changes in practices occurred at a particular hospital, within group comparisons over time periods are subject to the influence of the relative proportion of patients from each hospital. The ANZCPR does not collect data on intravascular crystalloid fluid administration perio- peratively and restriction of fluid addition in patients refusing transfusion likely plays a part in the intraopera- tive management of these patients.
Conclusion
We detail the management of CPB in JW patients com- pared with patients accepting blood transfusion using electronic data acquisition of perfusion parameters to a multicentre registry. Patients refusing blood product transfusion received greater incidence of intraoperative blood conservation interventions, had less postopera- tive blood loss and shorter hospital stay. Refusal of transfusion in patients undergoing CPB was associated with a significantly lower incidence of AKI and did not negatively impact mortality or morbidity compared to patients accepting transfusion. Reporting the actual intraoperative management of these patients provides opportunity to optimise patient outcomes.
Acknowledgements
This work was presented at The Perfusion Downunder Winter Meeting, August 2019, Noosa, Australia. ANZCPR Steering
Committee; Prof Rob Baker (Chair), Prof Alan Merry, Prof Paul Myles, Mr Richard Newland, Mr Timothy Willcox.
The ANZCPR is not directly funded and is supported by the contributing interested individuals and their institutions.
The following individuals contributed to the ANZCPR as Investigators (I) and/or Data Managers (DM) at each site: Alfred Hospital; James Anderson (I), Robin McEgan (I), Mark Mennen (I), Jessica Underwood (I), Wendy Saad (I), Nicholas Carr (DM, I), Joshua Byrne (DM, I), Ashford Hospital; Jane Ottens (I), Andrew Sanderson (DM, I), Cabrini Private Hospital; James McMillan (I), Michael McDonald (DM, I), Smita Gavande (I), Kyriakos Angus-Anagnostou (I), Kamala Garfield (I), Vanessa Perafan (I), Emerson Sgammotta (I), Sreenivasulu Galaeti (I), Vijaykumar Valiyapurayil (I), Gil Giovinazzo (I), Adam Wells (I), Ravi Kapoor (I), Rowan Carpenter (I), Flinders Private Hospital; Kuljeet Farrar (DM, I), Jane Ottens (I), Andrew Sanderson (I), Vijaykumar Valiyapurayil (I), Annette Mazzone (I), Flinders Medical Centre;, Kuljeet Farrar (I), Roy Romanowicz (I), Vijaykumar Valiyapurayil (I), Annette Mazzone (I), Auckland City Hospital; Misty Bean (DM, I), Jude Clark (I), Taryn Evans (I), Nathan Ibbott (I), Kathrine Morris (I), Rachael van Uden (I), Shuja Zahidani (I), Jill Chase (I), Luise van Wijk (I), Daryl Birchler (I), Alex Peterson (I), Mark Greaves (I), Thomas Hick (I), Ghaz Jabur (I), Cynthia Riddell (I), Camilla Hand (I), Kate Rawlings (I), Maddie Dobier (I), Royal Hobart Hospital; Carmel Fenton (DM, I), Nick Carr (I), YiYi Huang (DM, I), Royal Perth Hospital; Samantha Bizzell (I), Stuart Prince (DM, I), Viji Vincent (I), Brian Wright (I), Westmead Hospital; Grace Agbulos (I), Orison Kim (I), Monique Brouwer (I), Rona Steel (DM, I), Ray Miraziz (I), Peter Klineberg (I).
Flinders Cardiac Quality and Outcomes; Ms Bronwyn Kreig, Mr Chris Barratt, Ms Cynthia Edmonds contributed to the management of the ANZCPR..
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship and/or publication of this article.
ORCID iD
Timothy W Willcox https://orcid.org/0000-0003-1724 -0353
References
1. Be guided by the living god. The Watchtower, 2004, 15 June, pp. 19–24.
2. Lawson T, Ralph C. Perioperative Jehovah’s Witnesses: a review. Br J Anaesth 2015; 115: 676–687.
3. Australian Charter of Healthcare Rights. 2nd ed., https:// www.safetyandquality.gov.au/national-priorities/charter- of-healthcare-rights/review-of-the-charter-of-health- care-rights-second-edition (2019, accessed 20 July 2019).
4. Health and Disability Commissioner (Code of Health and Disability Services Consumers’ Rights) Regulations
APRIL 2022 | www.anzcp.org 40