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Han J, Ahmadi H, Ladi-Seyedian SS, Clifford TG, Douglawi A, Xu W, Bazargani ST, Mingo S, Thangathurai D, Daneshmand S, Djaladat H. Safety and feasibility of urological procedures in Jehovah's Witness patients. Int J Urol 2021; 29:83-88. [PMID: 34642972 DOI: 10.1111/iju.14721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the safety and feasibility of urological transfusion-free surgeries in Jehovah's Witness patients. METHODS An institutional review board-approved, retrospective review of Jehovah's Witness patients who underwent urological transfusion-free surgeries between 2003 and 2019 was carried out. Surgeries were stratified into low, intermediate and high risk based on complexity, invasiveness and bleeding potential. Patient demographics, perioperative data and clinical outcomes are reported. RESULTS A total of 161 Jehovah's Witness patients (median age 63.4 years) underwent 171 transfusion-free surgeries, including 57 (33.3%) in low-, 82 (47.9%) in intermediate- and 32 (18.8%) in high-risk categories. The mean estimated blood loss increased with risk category at 48 mL (range 10-50 mL), 150 mL (range 50-200 mL) and 388 mL (range 137-500 mL), respectively (P < 0.001). Implementing blood augmentation and conservation techniques increased with each risk category (3.5% vs 29% vs 69%, respectively; P < 0.001). Average length of stay increased concordantly at 1.6 days (range 0-12 days), 2.9 days (range 1-13 days) and 5.6 days (range 2-12 days), respectively (P ≤ 0.001). However, there was no increase in complication rates and readmission rates attributed to bleeding among the risk categories at 30 days (P = 0.9 and 0.4, respectively) and 90 days (P = 0.7 and 0.7, respectively). CONCLUSIONS Transfusion free urological surgery can be safely carried out on Jehovah's Witness patients using contemporary perioperative optimization. Additionally, these techniques can be expanded for use in the general patient population to avoid short- and long-term consequences of perioperative blood transfusion.
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Affiliation(s)
- Jullet Han
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Hamed Ahmadi
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Thomas G Clifford
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Antoin Douglawi
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Willem Xu
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Soroush T Bazargani
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Samuel Mingo
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Duraiyah Thangathurai
- Department of Anesthesia, Keck Medical Center, University of Southern California, Los Angeles, California, USA
| | - Siamak Daneshmand
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Hooman Djaladat
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Nazim SM, Fawzy M, Bach C, Ather MH. Multi-disciplinary and shared decision-making approach in the management of organ-confined prostate cancer. Arab J Urol 2018; 16:367-377. [PMID: 30534434 PMCID: PMC6277278 DOI: 10.1016/j.aju.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 01/24/2023] Open
Abstract
Decision-making in the management of organ-confined prostate cancer is complex as it is based on multi-factorial considerations. It is complicated by a multitude of issues, which are related to the patient, treatment, disease, availability of equipment(s), expertise, and physicians. Combination of all these factors play a major role in the decision-making process and provide for an interactive decision-making preferably in the multi-disciplinary team (MDT) meeting. MDT decisions are comprehensive and are often based on all factors including patients' biological status, disease and its aggressiveness, and physician and centres' expertise. However, one important and often under rated factor is patient-related factors. There is considerable evidence that patients and physicians have different goals for treatment and physicians' understanding of their own patients' preferences is not accurate. Several patient-related key factors have been identified such as age, religious beliefs, sexual health, educational background, and cognitive impairment. We have focused on these areas and highlight some key factors that need to be taken considered whilst counselling a patient and understanding his choice of treatment, which might not always be match with the clinicians' recommendation.
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Key Words
- (EB)RT, (external beam) radiotherapy
- ADT, androgen-deprivation therapy
- AS, active surveillance
- CCI, Charlson Comorbidity Index
- Decision-making
- ECE, extracapsular extension
- MDT, multi-disciplinary team
- Multi-disciplinary team (MDT)
- NCCN, National Comprehensive Cancer Network
- Patients’ preferences
- Prostate cancer
- QoL, quality of life
- RCT, randomised controlled trial
- RP, radical prostatectomy
- mpMRI, multiparametric MRI
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Affiliation(s)
- Syed M. Nazim
- Department of Urology, Aga Khan University, Karachi, Pakistan
| | - Mohamed Fawzy
- Department of Urology, University Hospital Aachen, Aachen, Germany
| | - Christian Bach
- Department of Urology, University Hospital Aachen, Aachen, Germany
| | - M. Hammad Ather
- Department of Urology, Aga Khan University, Karachi, Pakistan
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