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Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction
Author(s) -
Abt Nicholas B.,
Puram Sidharth V.,
Sinha Sumi,
Sethi Rosh K. V.,
Goyal Neerav,
Emerick Kevin S.,
Lin Derrick T.,
Deschler Daniel G.
Publication year - 2018
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27393
Subject(s) - medicine , surgery , blood transfusion , head and neck cancer , perioperative , head and neck , hematocrit , blood product , radiation therapy
Objective Blood product utilization is monitored to prevent unnecessary transfusions. Head‐and‐neck pedicled flap reconstruction transfusion‐related outcomes were assessed. Methods One hundred and thirty‐six pedicled flap patients were reviewed: 64 supraclavicular artery island flaps (SCAIF), 57 pectoralis major (PM) flaps, and 15 submental (SM) flaps. Outcome parameters included flap‐related complications, medical complications, length of stay (LOS), and flap survival. Multivariable logistic regression analyses were performed. Multivariable logistic regression analyses were performed to adjust for relevant pre‐ and perioperative factors. Results Of all head‐and‐neck pedicled flap patients included in our analyses (n = 136), 40 (29.4%) received blood transfusions. The average pretransfusion hematocrit (Hct) was 24.3% ± 0.5%, with 2.65 ± 0.33 units transfused and a posttransfusion Hct increase of 5.0% ± 0.6%. Transfusion rates differed with PM (47.4%), SCAIF (17.2%), and SM (13.3%) flaps ( P < 0.005). Patients undergoing PM reconstruction trended toward higher transfusion requirements (PM 2.89 ± 0.47 units, SC 2.18 ± 0.28 units, and SM 2.00 ± 0.0 units), with transfusion occurring later in the postoperative course (4.9 ± 1.3 days vs. 2.4 ± 0.1 days for all other flaps; P = 0.08). Infection, dehiscence, fistula, or medical complications were not different. Transfusion thresholds of Hct < 21 versus Hct < 27 exhibited no difference in LOS, flap‐survival, or medical/flap‐related complications. Conclusion Transfusion is not associated with surgical or medical morbidity following head and neck pedicled flap reconstruction. There were no differences in outcomes between transfusion triggers of Hct < 21 versus Hct < 27, suggesting that a more conservative transfusion trigger may not precipitate adverse patient complications. Our data recapitulate findings in free flap patients and warrant further investigation of transfusion practices in head and neck flap reconstruction. Level of Evidence 4. Laryngoscope , 128:E409–E415, 2018