Jehovah's witness head and neck free flap reconstruction patient outcomes

Matthew E Lin; Liyang Tang; Steven Hasday; Daniel I Kwon; Robert R Selby; Niels C Kokot

doi:10.1016/j.amjoto.2022.103681

Jehovah's witness head and neck free flap reconstruction patient outcomes

Am J Otolaryngol. 2023 Jan-Feb;44(1):103681. doi: 10.1016/j.amjoto.2022.103681. Epub 2022 Oct 21.

Authors

Matthew E Lin¹, Liyang Tang², Steven Hasday², Daniel I Kwon², Robert R Selby³, Niels C Kokot⁴

Affiliations

¹ Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
² Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
³ Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.
⁴ Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. Electronic address: Niels.Kokot@med.usc.edu.

PMID: 36335661
DOI: 10.1016/j.amjoto.2022.103681

Abstract

Background: Jehovah's Witnesses are members of a Christian religious denomination that rejects the transfusion of whole blood and component blood products. Given new transfusion-free strategies, Jehovah's Witness patients are undergoing free flap reconstructions with increased regularity. However, outcome data remains limited. With this study, we sought to examine post-operative outcomes in Jehovah's Witness patients undergoing free flap reconstruction of the head and neck, compare their outcomes to non-Jehovah's Witness patients, and enumerate strategies to enhance the safety of transfusion-free surgery.

Methods: A retrospective chart review was carried out on 10 patients who identified as Jehovah's Witness and 63 patients who did not. Demographic information, pre-operative laboratory values, peri-operative resuscitative interventions, and peri-operative outcome measures were compiled. Descriptive data analysis, Mann-Whitney, Chi-square tests, and multivariate analysis were used.

Results: Jehovah's Witness patients were significantly older than non-Jehovah's Witness patients (p = 0.03) and had significantly higher ASA scores (p = 0.009). Head and neck cancer was the primary surgical indication in both groups (p = 0.71). Jehovah's witness patients have significantly less intraoperative blood loss (p = 0.011) and lower post-operative hemoglobin (p = 0.002) compared to non-Jehovah's Witness patients. While Jehovah's Witness patients had significantly higher rates of severe anemia (p = 0.014), there was no significant difference between the two groups in other post-operative complications and readmission rates even in a multivariate analysis accounting for age and ASA score.

Conclusions: Free flap microvascular reconstruction can be reliably performed on Jehovah's Witness head and neck patients without an increased risk of complication. Policies such as the use of non-blood volume expanders, albumin, Epogen, perioperative iron supplementation, cell saver and acute normovolemic hemodilution are key to ensuring good outcomes.

Keywords: Free flap reconstruction; Head and neck reconstruction; Jehovah's witness; Outcomes; Transfusion free.

MeSH terms

Blood Loss, Surgical / prevention & control
Blood Transfusion
Free Tissue Flaps*
Humans
Jehovah's Witnesses*
Retrospective Studies