title: Blood transfusion prediction in patients undergoing major head and neck surgery with free-flap reconstruction.
abstract: OBJECTIVE
  to develop a clinically useful perioperative blood transfusion prediction model for patients undergoing a major head and neck surgical procedure requiring free-flap reconstruction.
  
  
  METHODS
  retrospective observational study.
  
  
  METHODS
  tertiary care university-affiliated teaching hospital (University Health Network, Toronto, Ontario, Canada).
  
  
  METHODS
  all patients with a head and neck malignant neoplasm undergoing major head and neck surgery requiring free-flap reconstruction.
  
  
  METHODS
  perioperative single-unit red blood cell transfusion.
  
  
  RESULTS
  all the preoperative variables were tested for an association with perioperative blood transfusion using univariable and multivariable analyses. After multivariable regression analysis, the following preoperative variables were found to be significantly associated with perioperative transfusion: sex, body mass index, T stage, preoperative hemoglobin level, and type of free-flap reconstruction used (ie, osseous vs nonosseous). The regression model was used to develop a transfusion risk score. Receiver operating characteristic curve analysis confirmed adequate discrimination of risk using the transfusion risk score.
  
  
  CONCLUSIONS
  we have developed a reliable model for predicting perioperative blood transfusion requirements in patients undergoing major head and neck surgery requiring free-flap reconstruction. This model can be used for accurate preoperative risk stratification.
authors.affiliation: Departments of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Princess Margaret Hospital, University Health Network, 3-955 Wharton Head and Neck Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada.
authors.forename: Manish D
authors.initials: MD
authors.lastname: Shah
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Stuart A
authors.initials: SA
authors.lastname: McCluskey
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Hofer
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.forename: Dale H
authors.initials: DH
authors.lastname: Brown
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Irish
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Gilbert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D002648:Child; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D055815:Young Adult