Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery. Issue 2 (31st January 2021)

• Record Type: Journal Article
• Authors: Jones, Alexander Joseph; Campiti, Vincent J.; Alwani, Mohamedkazim; Novinger, Leah J.; Tucker, Brady Jay; Bonetto, Andrea; Yesensky, Jessica A.; Sim, Michael W.; Moore, Michael G.; Mantravadi, Avinash V.
• Is Part Of: Laryngoscope investigative otolaryngology. Volume 6:Issue 2(2021)
• Page Start: 200
• Page End: 210
• Publication Date: 2021-01-31
• Subjects: blood transfusion -- free flap reconstruction -- head and neck cancer -- sarcopenia -- skeletal muscle index; Otolaryngology -- Periodicals; Laryngoscopy -- Periodicals; Otolaryngology; Otolaryngology; Periodicals; Periodicals; 617.51
• DOI: 10.1002/lio2.530
• Languages: English
• ISSNs: 2378-8038

Abstract

Abstract: Objective: To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR). Methods: A single‐institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm 2 /m 2 ), oncologic history, intraoperative data, and 30‐day postoperative complications (Clavien‐Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion. Results: Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty‐two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age ( P = .035), more frequent alcoholism ( P = .028) and sarcopenia ( P < .001), greater mCCI ( P < .001), lower preoperative hemoglobin ( P < .001), reconstruction with flaps other than forearm ( P = .003), and greater operative times ( P = .001), intravenous fluids ( P < .001), and estimated blood loss (EBL, P < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; P < .001). Multivariate regression determined sarcopenia ( P = .023), mCCI ( P = .013), preoperative hemoglobin ( P = .002), operative time ( P = .036), and EBL ( P < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin ( P = .007), osseous flap ( P = .036), and CD ≥ 3 ( P < .001). A perioperative transfusion was predicted by sarcopenia ( P = .021), preoperative hemoglobin ( P < .001), operative time ( P = .008), and CD ≥ 3 ( P = .018). Conclusion: Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource‐limited scenarios. Level of Evidence: 4. Abstract : Head and neck cancer free flap reconstruction patients are at particularly high risk of requiring perioperative blood transfusions, which imposes additional risks and consequences. Sarcopenia, which was determined by measuring skeletal muscle mass using preoperative CT imaging, is highly prevalent in this patient population and has been associated with worse perioperative outcomes. In this retrospective cohort study, we determined that sarcopenia was and independent risk factor for blood transfusion after accounting for comorbidities, operative factors, and complications in head and neck cancer free flap reconstruction patients.