Intraoperative Transfusion of Packed Red Blood Cells in Microvascular Free Tissue Transfer Patients: Assessment of 30-Day Morbidity Using the NSQIP Dataset

Kim, Bobby D.; Halen, Jon P. Ver; Mlodinow, Alexei S.; Kim, John Y.S.

doi:10.1055/s-0033-1357275

Cited by 35 publications

(42 citation statements)

References 45 publications

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“…Indeed, even intraoperative transfusion has been associated flap take-back. 9 In our cohort, based on the day of transfusion and the day of take-back, in the vast majority of cases hematoma formation preceded transfusion and thus was likely the antecedent event rather than the cause.…”

Section: Discussionmentioning

confidence: 77%

“…Hematoma formation causing flap take‐back leads to acute blood loss itself or additional blood loss from the subsequent surgery, making transfusion more likely. Indeed, even intraoperative transfusion has been associated flap take‐back . In our cohort, based on the day of transfusion and the day of take‐back, in the vast majority of cases hematoma formation preceded transfusion and thus was likely the antecedent event rather than the cause.…”

Section: Discussionmentioning

confidence: 84%

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Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

et al. 2018

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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

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 84%

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

et al. 2018

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“…25 A recent retrospective review demonstrated that intraoperative blood transfusion was associated with higher rates of overall complications, medical complications, postoperative transfusion, and reoperation. 61 In addition, perioperative blood transfusions have a well-documented association with increased morbidity and mortality, including head and neck cancer recurrence, in free flap reconstruction. 26,27,[62][63][64][65][66][67][68][69] Other studies have suggested a link between blood transfusions and wound infections.…”

Section: Blood Transfusionmentioning

confidence: 99%

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

Motakef

Mountziaris

Ismail

et al. 2015

Plastic and Reconstructive Surgery

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Current practices remain exceedingly diverse. Key strategies to improve patient outcomes can be defined from the available literature. Key evidence-based guidelines included that normothermia should be maintained perioperatively to improve outcomes (level of evidence 2b), and volume replacement should be maintained between 3.5 and 6.0 ml/kg per hour (level of evidence 2b). Vasopressors do not harm outcomes and may improve flap flow (level of evidence 1b), with most evidence supporting the use of norepinephrine over other vasopressors (level of evidence 1b). Dextran should be avoided (level of evidence 1b), and pump systems for local anesthetic infusion are beneficial following free flap breast reconstruction (level of evidence 1b). Further prospective studies will improve the quality of available evidence.

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“…[9, 11, 12] Despite the liberal use of transfusion in many oncology studies, there are little data to support the efficacy of correcting anemia with transfusion. [13] In fact, there is evidence that suggests that blood transfusions are independently associated with worse perioperative and oncologic outcomes.…”

Section: Introductionmentioning

confidence: 99%

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

Prescott

Taylor

López-Olivo

et al. 2016

Cancer Treatment Reviews

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Background Most non-oncologic clinical practice guidelines recommend restrictive allogeneic blood transfusion practices; however, there is a lack of consensus regarding the best transfusion practice in oncology. We conducted a systematic review of the literature to compare the efficacy and safety of restrictive versus liberal transfusion strategies in patients with cancer. Methods A literature search using MEDLINE, PUBMED and EMBASE identified all controlled studies comparing the use of restrictive with liberal transfusion in adult oncology participants up to August 10, 2015. Two review authors independently assessed studies for inclusion, extracted data and appraised the quality of the included studies. The primary outcomes of interest were blood utilization and all-cause mortality. Results Out of 4241 citations, six studies (3 randomized and 3 non-randomized) involving a total of 983 patients were included in the final review. The clinical context of the studies varied with 3 chemotherapy and 3 surgical studies. The overall risk of bias in all studies was moderate to high. Restrictive transfusion strategies were associated with a 36% reduced risk of receiving a perioperative transfusion (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.49 to 0.83). There was no difference in mortality between the strategies (RR 1.00, 95% CI 0.32 to 3.18). There were no differences in adverse events reported between the restrictive and liberal transfusion strategies. Conclusion Restrictive strategy appears to decrease blood utilization without increasing morbidity or mortality in oncology. This review is limited by a paucity of high quality studies on this topic. Better designed studies are warranted.

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Intraoperative Transfusion of Packed Red Blood Cells in Microvascular Free Tissue Transfer Patients: Assessment of 30-Day Morbidity Using the NSQIP Dataset

Cited by 35 publications

References 45 publications

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

Transfusion in Head and Neck Cancer Patients Undergoing Pedicled Flap Reconstruction

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

How low should we go: A systematic review and meta-analysis of the impact of restrictive red blood cell transfusion strategies in oncology

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