Role of arthroplasty in the Jehovah’s Witness population

Mottla, Jay; Murphy, Jordan; Keeling, Laura E.; Verstraete, Richard; Zawadsky, Mark W.

doi:10.1007/s00590-020-02852-7

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…9 In addition, this is in accordance with a recent review on JW by Mottla et al which stated that with a preoperative optimization programme, arthroplasties are safe. 10 Moreover, RBCs transfusion have several adverse effects identified in different studies. These comprise longer hospital stays, increased 90-day mortality, post-operative cardiac complications, acute haemolytic reactions, pneumonia and bacterial infections.…”

Section: Discussionmentioning

confidence: 99%

Perioperative blood management programme in Jehovah’s witnesses undergoing total knee arthroplasty: clinical results and cost-benefit analysis

Vicenti,

Solarino,

Zaccari

et al. 2023

Orthopedic Reviews

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Introduction Total knee arthroplasties have the purpose to improve quality of life from joint-related pain. On the other hand, it may represent a risky surgical procedure in people who refuse blood products due to their religious beliefs, such as Jehovah’s Witnesses (JW). Preoperative optimization protocols of these patients allow performing arthroplasties in a safer manner avoiding allogeneic blood transfusion. Methods In our retrospective study, 2 groups of patients were evaluated. Group 1, included JW patients who underwent a preoperative Hb optimisation programme; group 2 included non-JW patients authorizing transfusion in case of necessity. Results Differences in Hb levels were: before surgery (JW 13,63±1,26 vs. non-JW 12,83±1,21, p-value=0,22), after surgery (day 1 Hb: JW 12,26±1,47 vs. non-JW 10,88±1,87, p-value=0,1; day 3 Hb: JW 10±2,97 vs. non-JW 9,23±1,07 p-value=0,64). In the JW group the mean Hb concentration decreased from 13,63±1,26 g/dL preoperatively to 12,26±1,47 g/dL (day 1) while in non-JW group fell from 12,83± g/dL to 10,88± g/dL. There was no statistically-difference between the 2 groups. Moreover, cost-effectiveness strategies were evaluated in both groups. Conclusion Our findings support that PBM programs represent a safe and good strategy in knee prosthetic surgery, decreasing costs, risks and transfusion overuse.

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Section: Discussionmentioning

confidence: 99%

Perioperative blood management programme in Jehovah’s witnesses undergoing total knee arthroplasty: clinical results and cost-benefit analysis

Vicenti,

Solarino,

Zaccari

et al. 2023

Orthopedic Reviews

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“…A successful outcome depends in part on the adoption of a comprehensive multimodal blood management protocol. As these protocols are well established in the developed world, it is not surprising that all six published studies describing the outcome of revision THA in JW patients have been conducted in the United States and the United Kingdom [6,7,[11][12][13][14] (Table 1). In establishing an arthroplasty program in Trinidad, we are confronted with several unique challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Bloodless surgery protocols, developed in part to meet the needs of the JW population, are part of any contemporary arthroplasty program [5]. While several studies have reported successful outcomes of primary THA in the JW population, there remains a paucity of data on patients who undergo revision THA [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Revision Total Hip Arthroplasty in Jehovah’s Witnesses at a Public Hospital: Practical Recommendations for a Low-Resource Setting

Mencia

Beharry²,

Cruz³

2021

Cureus

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Revision total hip arthroplasty (THA) is a major reconstructive procedure traditionally associated with significant blood loss. Jehovah's Witnesses (JW) do not accept blood or blood product transfusions because of their religious beliefs. When confronted with a JW patient requiring a complex arthroplasty procedure, surgeons face moral and ethical questions and may be reluctant to perform surgery. A successful outcome depends on several factors including surgical and anesthetic expertise, a range of revision implants, and a multimodal blood management protocol. While these resources are readily available in a developed country, in many of the developing Caribbean islands, the healthcare system is underfunded and under-resourced.Here, we describe our experience performing a revision THA on a JW patient in the Caribbean. Through this case report, we aim to illustrate our approach to blood management by exploring the fundamental elements that were employed in a low-resource setting. We believe that the extrapolation of these crucial principles to the broader category of primary arthroplasty in the general population can be used to reduce the rate of blood transfusion, increase access to surgery, and improve outcomes.

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“…The multimodal PBM approach is more effective than the traditional transfusion approach, from both a clinical and an economic point of view. Nevertheless, the costeffectiveness of Hb optimisation as a single PBM strategy has not been evaluated in patients undergoing orthopaedic surgery [4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…PBM programs that reduce the risk and use of transfusions also have reverberations about ethical, spiritual, and religious issues [4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Blood Management Programme in Jehovah’s Witnesses Undergoing Total Hip Arthroplasty

Solarino,

Vicenti,

Bizzoca

et al. 2023

Prosthesis

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Total hip arthroplasties aim to improve quality of life and reduce pain in patients suffering from late-stage hip osteoarthritis. On the other hand, it may represent a risky surgical procedure in people who refuse blood products because of religious beliefs, such as Jehovah’s Witnesses (JW). Preoperative optimisation protocols of these patients allow medical professionals to perform arthroplasties in a safer manner, avoiding allogeneic blood transfusion. In our retrospective study, two groups of patients were evaluated. Group 1 included JW patients who underwent a preoperative Hb optimisation program; Group 2 included non-JW patients authorizing transfusion in case of necessity. Differences in Hb levels were as follows: before surgery (JW 14.24 ± 1.10 vs. non-JW 12.48 ± 1.00, p-value ≤ 0.05), and after surgery (day 1 Hb: JW 12.88 ± 0.90 vs. non-JW 10.04 ± 1.30, p-value ≤ 0.05; day 3 Hb: JW 14.65 ± 0.80 vs. non-JW 9.10 ± 0.90 p-value ≤ 0.05). Moreover, cost-effectiveness strategies were evaluated in both groups. Our findings support that patient blood management programs are a safe and good strategy in hip prosthetic surgery, decreasing risks and transfusion overuse.

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Role of arthroplasty in the Jehovah’s Witness population

Cited by 7 publications

References 34 publications

Perioperative blood management programme in Jehovah’s witnesses undergoing total knee arthroplasty: clinical results and cost-benefit analysis

Perioperative blood management programme in Jehovah’s witnesses undergoing total knee arthroplasty: clinical results and cost-benefit analysis

Revision Total Hip Arthroplasty in Jehovah’s Witnesses at a Public Hospital: Practical Recommendations for a Low-Resource Setting

Perioperative Blood Management Programme in Jehovah’s Witnesses Undergoing Total Hip Arthroplasty

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