Avoiding transfusion in head and neck surgery: feasibility study of erythropoietin.
OBJECTIVE
To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery.


METHODS
Retrospective chart review.


METHODS
Ninety-nine patients undergoing surgical resection of head and neck tumors at our institution were assessed for demographic data, nutritional parameters, tumor/surgical information, hematological/transfusion data, and contraindications to erythropoietin. Each transfusion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also performed.


RESULTS
Most transfused patients (63%) received too many units. A subgroup at high risk of transfusion was identified who would benefit most from perioperative erythropoietin. Assuming that perioperative erythropoietin therapy is equivalent to the transfusion of 4 units, we estimate that the majority (741%) of transfused patients would not have required a transfusion if more stringent transfusion criteria were followed and those at high risk were given perioperative erythropoietin. Although the cost for transfusing 4 units is equivalent to that of a perioperative course of erythropoietin, the overall direct cost of erythropoietin treatment would actually have been more expensive.


CONCLUSIONS
Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prospective randomized controlled study in such a subgroup is needed to better define those most likely to benefit from it and to assess actual cost/benefit ratios.
Sturgis
E M
EM
Department of Otolaryngology--Head and Neck Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. esturgis@notes.mdacc.tmc.edu
Gianoli
G J
GJ
Miller
R H
RH
Fisher
J W
JW
D000328:Adult; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D000075202:Contraindications; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000191:economics / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
D004921:Erythropoietin