Neurosurgical procedures in Jehovah's witnesses: An increased risk?

OBJECTIVE: Because of the growing numbers of members worldwide in the sect of Jehovah's Witnesses, the refusal of blood and blood products due to reli gious reasons is increasingly encountered in clinical practice. As an alter native to blood transfusion, Jehovah's Witnesses accept blood-free volume s ubstitution, and they sometimes accept the intraoperative reinfusion of aut ologous blood via a so-called cell saver. The aim of this study was to exam ine whether the refusal of blood transfusion affects the surgical indicatio ns for neurosurgery and whether morbidity and mortality rates are higher af ter neurosurgical interventions in Jehovah's Witnesses. METHODS: The pre-, intra-, and postoperative hemoglobin and hernatocrit val ues as well as coagulation parameters of a group of Jehovah's Witnesses (n = 103) were compared with those of a valid control group. RESULTS: The total intraoperative blood loss during spinal and intracranial surgery in Jehovah's Witnesses was often less than in controls, which sugg ests a less traumatic surgical procedure. Hemodynamically relevant blood lo ss occurred in two spinal and four intracranial interventions. The patients were managed without receiving blood transfusions or blood products, altho ugh increased time in the intensive care unit and increased convalescence d ays were necessary. Mean surgical times were 17.5 minutes longer for spinal interventions and 36.7 minutes longer for intracranial interventions than for patients in the control group. This may be attributed to a more careful and thus slower surgical technique and to longer and more extensive hemost asis. The length of hospitalization was 15% longer for Jehovah's Witnesses than for controls. CONCLUSION: The morbidity and mortality rates for Jehovah's Witnesses under going neurosurgery were not higher than those of the control group. Thus, i t can be concluded that Jehovah's Witnesses did not have a higher risk when microsurgical techniques and extensive anesthetic monitoring were applied during neurosurgery. Because the surgical success rate for Jehovah's Witnes ses corresponded to that of the control group, the increase in costs becaus e of longer treatment times is compensated in the long run by avoiding a le ngthier illness, sometimes with more expensive conservative therapy.