title: Transfusion in head and neck free flap patients: practice patterns and a comparative analysis by flap type.
abstract: OBJECTIVE
  To characterize patterns of utilization and outcomes following transfusion in head and neck patients undergoing free flap reconstruction.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Two hundred eighty-two head and neck patients undergoing free flap reconstruction from 2011 to 2013. Outcome parameters included post-transfusion hematocrit increase, length of stay (LOS), flap survival, and perioperative complications.
  
  
  RESULTS
  Of all head and neck free flap patients, 48.9% received blood transfusions. Average pretransfusion hametocrit (Hct) was 24.7%±0.2% with 2.5±0.1 units of blood transfused. Transfused patients were more likely to have been taken back to the operating room. Rates of transfusion were similar between flap types, although anterolateral thigh (ALT) and fibular free flap (FFF) patients had higher transfusion requirements compared to radial forearm free flap (RFFF) patients. Further, FFF patients trended toward receiving transfusions earlier. Transfusion did not influence flap survival but was associated with wound dehiscence, myocardial infarction, congestive heart failure, respiratory distress, and pneumonia. Subset analyses by flap type revealed that differences were significant among the RFFF and FFF cohorts but not ALT patients. When comparing patients who were transfused for Hct<21 to those transfused for Hct<27, there were no differences in LOS, flap survival, or postsurgical complications.
  
  
  CONCLUSIONS
  Among the different types of flaps, FFF and ALT are associated with higher transfusion requirements. Transfusion in patients undergoing free flap reconstruction does not significantly affect flap survival but was associated with perioperative complications. Our data support consideration of a restrictive transfusion policy in free flap patients.
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Sidharth V
authors: SV
authors: Puram
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Bharat B
authors: BB
authors: Yarlagadda
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Rosh
authors: R
authors: Sethi
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Vinayak
authors: V
authors: Muralidhar
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Kyle J
authors: KJ
authors: Chambers
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Kevin S
authors: KS
authors: Emerick
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: James W
authors: JW
authors: Rocco
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors: Derrick T
authors: DT
authors: Lin
authors: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA daniel_deschler@meei.harvard.edu.
authors: Daniel G
authors: DG
authors: Deschler
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000592:standards*; D044964:Cervicoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies
keywords: free flap; head and neck cancer; transfusion