Sidharth V Puram 1 , Bharat B Yarlagadda 1 , Rosh Sethi 1 , Vinayak Muralidhar 1 , Kyle J Chambers 1 , Kevin S Emerick 1 , James W Rocco 1 , Derrick T Lin 1 , Daniel G Deschler 2 Show Affiliations »
Abstract
OBJECTIVE: To characterize patterns of utilization and outcomes following transfusion in head and neck patients undergoing free flap reconstruction. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. SUBJECTS AND METHODS: Two hundred eighty-two head and neck patients undergoing free flap reconstruction from 2011 to 2013. Outcome parameters included post-transfusion hematocrit increase, length of stay (LOS), flap survival, and perioperative complications. RESULTS: Of all head and neck free flap patients, 48.9% received blood transfusions. Average pretransfusion hametocrit (Hct) was 24.7%±0.2% with 2.5±0.1 units of blood transfused. Transfused patients were more likely to have been taken back to the operating room. Rates of transfusion were similar between flap types, although anterolateral thigh (ALT) and fibular free flap (FFF) patients had higher transfusion requirements compared to radial forearm free flap (RFFF) patients. Further, FFF patients trended toward receiving transfusions earlier. Transfusion did not influence flap survival but was associated with wound dehiscence, myocardial infarction, congestive heart failure, respiratory distress, and pneumonia. Subset analyses by flap type revealed that differences were significant among the RFFF and FFF cohorts but not ALT patients. When comparing patients who were transfused for Hct<21 to those transfused for Hct<27, there were no differences in LOS, flap survival, or postsurgical complications. CONCLUSIONS: Among the different types of flaps, FFF and ALT are associated with higher transfusion requirements. Transfusion in patients undergoing free flap reconstruction does not significantly affect flap survival but was associated with perioperative complications. Our data support consideration of a restrictive transfusion policy in free flap patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
OBJECTIVE: To characterize patterns of utilization and outcomes following transfusion in head and neck patients undergoing free flap reconstruction. STUDY DESIGN: Case series with chart review. SETTING: Tertiary academic medical center. SUBJECTS AND METHODS: Two hundred eighty-two head and neck patients undergoing free flap reconstruction from 2011 to 2013. Outcome parameters included post-transfusion hematocrit increase, length of stay (LOS), flap survival, and perioperative complications. RESULTS: Of all head and neck free flap patients , 48.9% received blood transfusions. Average pretransfusion hametocrit (Hct) was 24.7%±0.2% with 2.5±0.1 units of blood transfused. Transfused patients were more likely to have been taken back to the operating room. Rates of transfusion were similar between flap types, although anterolateral thigh (ALT) and fibular free flap (FFF) patients had higher transfusion requirements compared to radial forearm free flap (RFFF) patients . Further, FFF patients trended toward receiving transfusions earlier. Transfusion did not influence flap survival but was associated with wound dehiscence, myocardial infarction , congestive heart failure , respiratory distress, and pneumonia . Subset analyses by flap type revealed that differences were significant among the RFFF and FFF cohorts but not ALT patients . When comparing patients who were transfused for Hct<21 to those transfused for Hct<27, there were no differences in LOS, flap survival, or postsurgical complications. CONCLUSIONS: Among the different types of flaps, FFF and ALT are associated with higher transfusion requirements. Transfusion in patients undergoing free flap reconstruction does not significantly affect flap survival but was associated with perioperative complications. Our data support consideration of a restrictive transfusion policy in free flap patients . © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Entities: Disease
Species
Keywords:
free flap; head and neck cancer; transfusion
Mesh： See more »
Year: 2015
PMID： 25628368 DOI： 10.1177/0194599814567107
Source DB: PubMed Journal: Otolaryngol Head Neck Surg ISSN： 0194-5998 Impact factor: 3.497