Severe Acute Blood Loss Anemia in Jehovah's Witnesses Undergoing Cardiac Surgery: Single Academic Center Experience.

OBJECTIVE: To determine the effect of severe acute blood loss anemia (ABLA) on postoperative outcomes in Jehovah's Witness (JW) patients undergoing cardiac surgery. DESIGN: This was a retrospective cohort study of adult JW patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB) between January 1998 and December 2018 at Barnes-Jewish Hospital in St. Louis, Missouri. SETTING: At a single tertiary academic center. PARTICIPANTS: Patients who were JWs undergoing cardiac surgery requiring CPB. INTERVENTIONS: Patients were divided into the following 2 groups: JW patients who developed severe ABLA (defined as postoperative hematocrit level <21), and patients who did not develop severe ABLA. MEASUREMENTS AND MAIN RESULTS: A total of 48 JW patients who underwent cardiac surgery between 2008 and 2018 were identified. Of these patients, 9 (18.8%) developed postoperative severe ABLA, and 39 (81.3%) did not. Severe ABLA was associated with increased postoperative mortality at 30-days, 90-days, and 1-year postoperatively, and a trend toward increased hospital length of stay. CONCLUSIONS: Severe ABLA after cardiac surgery was associated with higher mortality and a trend toward increased hospital length of stay among JW patients. More data are required to confirm the findings.

Comprehensive Assessment of Current Management Strategies for Patients With Diabetes and Chronic Limb-Threatening Ischemia.

Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease. It is estimated that 60% of all nontraumatic lower-extremity amputations performed annually in the United States are in patients with diabetes and CLTI. The consequences of this condition are extraordinary, with substantial patient morbidity and mortality and high socioeconomic costs. Strategies that optimize the success of arterial revascularization in this unique patient population can have a substantial public health impact and improve patient outcomes. This article provides an up-to-date comprehensive assessment of management strategies for patients afflicted by both diabetes and CLTI.