Impact of Surgical Urgency on Outcomes and Postoperative Anemia in Jehovah’s Witnesses Undergoing Cardiovascular Surgery

Background This study aimed to examine the outcomes of cardiovascular surgery in Jehovah’s witnesses (JWs) according to surgical urgency (elective vs. emergency), investigate the relationship between surgical urgency and postoperative anemia progression, and determine the impact of postoperative anemia on overall mortality. Methods JW patients undergoing cardiovascular surgery were categorized into elective ( n = 35) and emergency ( n = 7) groups. Baseline characteristics, intraoperative data, postoperative complications, and all‐cause mortality were compared. Postoperative hemoglobin (Hb) trends were analyzed using linear mixed‐effects models. Survival analysis, including multivariable Cox proportional hazards regression, identified independent risk factors for mortality. Results Emergent cases had lower preoperative Hb (12.2 [11.3–12.3] vs. 13.5 [12.2–14.4] g/dL, p = 0.024) and higher incidence of acute type A aortic dissection (85.7% vs. 2.9%) than elective cases. Perioperative Hb levels were significantly lower in emergent patients demonstrating higher rates of 30‐day mortality (42.9% vs. 2.9%, p = 0.011). Survival analysis showed a significant difference favoring the elective group ( p = 0.003). Cox proportional hazards analysis revealed that emergency surgery (HR, 4.01 and 95% confidence interval [CI], 1.13–14.19) and the lowest postoperative Hb level (HR, 0.66 and 95% CI, 0.45–0.98) were shown to be independent predictors of postoperative mortality. Conclusions Emergency cardiovascular surgery in JWs is associated with significantly poorer outcomes, including higher mortality and more severe postoperative anemia, compared with elective procedures. Severe postoperative anemia is an independent predictor of postoperative mortality. These findings underscore the critical need for intensified patient blood management strategies, even in emergent settings, to mitigate risks in this vulnerable patient population.