Background/objectives: Major head and neck oncologic surgeries requiring microvascular reconstruction frequently result in complications such as perioperative blood transfusion (PBT). Not only are blood products overutilized and associated with risks, but preoperative anemia is both a modifiable and predisposing factor for PBT. Our objective was to assess risk factors for PBT and determine a high-risk preoperative hemoglobin to inform transfusion stewardship practices.Methods: Patients that underwent head and neck cancer free flap reconstruction (n= 363) between 2012 and 2019 were included. Univariable and multivariable analyses evaluated predictors of PBT.Results: Overall, 11% of patients were anemic and 19% were transfused. Mean preoperative hemoglobin was significantly lower in the PBT group (128 g/L vs. 145 g/L,p< 0.0001). In our multivariable model, lower preoperative hemoglobin (odds ratio [OR] = 0.94), higher T stage (OR = 2.65), and lower body mass index (BMI) (OR = 0.89) increased the odds of PBT. Adjusting for staging and BMI, the OR of PBT was increased below 120 g/L hemoglobin. Higher mean units of PBT were administered for hemoglobin below 150 g/L with a large inflection below 120 g/L (p< 0.0001).Conclusions: Low preoperative hemoglobin is the strongest predictor of PBT in major head and neck cancer surgery. Recognizing and managing anemia is essential in surgical planning.
背景/目的：需要显微血管重建的头颈部大型肿瘤手术常导致围手术期输血等并发症。血液制品不仅存在过度使用及相关风险，术前贫血更是围手术期输血的可调控诱发因素。本研究旨在评估围手术期输血的风险因素，并确定需警惕的高危术前血红蛋白阈值，以指导输血管理实践。 方法：纳入2012年至2019年间接受头颈癌游离皮瓣重建术的患者（n=363）。通过单变量与多变量分析评估围手术期输血的预测因素。 结果：总体患者中，11%存在贫血，19%接受输血。围手术期输血组的平均术前血红蛋白显著降低（128 g/L vs. 145 g/L，p<0.0001）。多变量模型显示，较低的术前血红蛋白（比值比[OR]=0.94）、较高的T分期（OR=2.65）及较低的身体质量指数（OR=0.89）均会增加围手术期输血风险。在调整分期和身体质量指数后，血红蛋白低于120 g/L时围手术期输血风险显著上升。当血红蛋白低于150 g/L时输血量明显增加，其中低于120 g/L时出现急剧上升拐点（p<0.0001）。 结论：术前低血红蛋白是头颈部大型肿瘤手术围手术期输血的最强预测因素。在手术规划中识别并处理贫血至关重要。
肿瘤(癌症)患者之家