title: Impact of blood transfusions on patients with head and neck cancer undergoing free tissue transfer.
abstract: OBJECTIVE
  To determine whether blood transfusions are associated with adverse outcomes in patients with head and neck cancer (HNC) undergoing microvascular free tissue transfer.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The records of all patients who underwent free flaps for reconstruction after HNC resection from July 2007 through February 2013 at a single institution were reviewed. Rates of overall survival (OS), recurrence free survival (RFS), and postoperative wound infection were determined. Statistical analyses included Cox proportional hazards models and chi-square tests.
  
  
  RESULTS
  Of 167 patients, 90 received 0 to 2 units of blood and 77 received ≥ 3. After controlling for age, preoperative hemoglobin, preoperative albumin, cancer stage, and adverse pathologic features, transfusion of ≥ 3 (versus 0 to 2) units was associated with poorer OS (P = 0.0006; hazard ratio [HR] = 2.96) and RFS (P = 0.003; HR = 2.35). The rates of wound infection in patients who received 0, 1, 2, or ≥ 3 units were 13.3%, 21.2%, 33.3%, and 31.2%, respectively. There was a statistically significant difference in wound infection rates between those patients receiving 0 to 1 versus ≥ 2 units (P = 0.04).
  
  
  CONCLUSIONS
  Patients who receive ≥ 3 units of blood after free tissue transfer for HNC had a significantly increased risk of death after controlling for age, preoperative hemoglobin and albumin, cancer stage, and adverse pathologic features. Increased transfusions are also associated with higher wound infection rates. The increased tendency to transfuse free flap patients in order to maintain a threshold hematocrit may have a detrimental impact on survival and wound infections and should be revisited.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: Deepa
authors.initials: D
authors.lastname: Danan
authors.forename: Mark E
authors.initials: ME
authors.lastname: Smolkin
authors.forename: Nikole E
authors.initials: NE
authors.lastname: Varhegyi
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Bakos
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Jameson
authors.forename: David C
authors.initials: DC
authors.lastname: Shonka
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D058752:Free Tissue Flaps / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology; D006400:Hematocrit; D006452:Hemoglobinometry; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D065227:Transfusion Reaction
keywords: Blood transfusions; free flaps; free tissue transfer; head and neck cancer; microvascular