Impact of blood transfusions on patients with head and neck cancer undergoing free tissue transfer. (14th August 2014)

• Record Type: Journal Article
• Authors: Danan, Deepa; Smolkin, Mark E.; Varhegyi, Nikole E.; Bakos, Stephen R.; Jameson, Mark J.; Shonka, David C.
• Is Part Of: Laryngoscope. Volume 125:Number 1(2015:Jan.)
• Page Start: 86
• Page End: 91
• Publication Date: 2014-08-14
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.24847
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary24847-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>To determine whether blood transfusions are associated with adverse outcomes in patients with head and neck cancer (HNC) undergoing microvascular free tissue transfer.</p> </sec> <sec id="lary24847-sec-0002" sec-type="section"> <title>Study Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="lary24847-sec-0003" sec-type="section"> <title>Methods</title> <p>The records of all patients who underwent free flaps for reconstruction after HNC resection from July 2007 through February 2013 at a single institution were reviewed. Rates of overall survival (OS), recurrence free survival (RFS), and postoperative wound infection were determined. Statistical analyses included Cox proportional hazards models and chi‐square tests.</p> </sec> <sec id="lary24847-sec-0004" sec-type="section"> <title>Results</title> <p>Of 167 patients, 90 received 0 to 2 units of blood and 77 received ≥ 3. After controlling for age, preoperative hemoglobin, preoperative albumin, cancer stage, and adverse pathologic features, transfusion of ≥ 3 (versus 0 to 2) units was associated with poorer OS (<italic>P</italic> = 0.0006; hazard ratio [HR] = 2.96) and RFS (<italic>P</italic> = 0.003; HR = 2.35). The rates of wound infection in patients who received 0, 1, 2, or ≥ 3 units were 13.3%, 21.2%, 33.3%, and 31.2%, respectively. There was a statistically significant difference in wound infection rates between those patients receiving 0 to 1 versus ≥ 2 units (<italic>P</italic> = 0.04).</p> </sec> <sec id="lary24847-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Patients who receive ≥ 3 units of blood after free tissue transfer for HNC had a significantly increased risk of death after controlling for age, preoperative hemoglobin and albumin, cancer stage, and adverse pathologic features. Increased transfusions are also associated with higher wound infection rates. The increased tendency to transfuse free flap patients in order to maintain a threshold hematocrit may have a detrimental impact on survival and wound infections and should be revisited.</p> </sec> <sec id="lary24847-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>2b. <italic>Laryngoscope</italic>, 125:86–91, 2015</p> </sec> </abstract>