title: Predictors of Intraoperative Blood Transfusion in Free Tissue Transfer.
abstract: BackgroundFree tissue transfer has become a safe and reliable procedure and is routinely used in a variety of settings. However, it is associated with lengthy operating times and a high potential for blood loss and consecutive red blood cell transfusions (RBCTs).MethodsTo assess the risk for RBCTs, we retrospectively identified 398 patients undergoing free tissue transfer between 2005 and 2014. Based on a multivariate model of risk factors and their respective odds ratio, a risk score was developed to predict the likelihood of the need for intraoperative RBCT.ResultsThe median age at the time of operation was 51.3 ± 15 years, and 278 (70%) patients were male. The average body mass index was 25.9 ± 4 and the median ASA score was 2 (range: 1-4). Mean duration of surgery was 319.8 ± 108 minutes and mean duration of hospital stay was 45.8 ± 40 days. A total of 231 patients (58%) required perioperative RBCTs, all of which were allogenic. RBCTs were performed 0 to 48 hours preoperatively in 36 patients (11.3%), intraoperatively in 166 patients (41.7%), and 0 to 48 hours postoperatively in 125 patients (31.4%). The mean amount of overall RBCTs given was 2.5 ± 3.7 units and 1.1 ± 1.9 units for intraoperative transfusions. The following risk factors were statistically significant in the multivariate regression analysis and included in the risk score: age >60 years; a preoperative hemoglobin concentration of <11 g/dL; a preoperative platelet count of >400/nL; history of renal (RI) and cardial insufficiency (CI); defect localization on the proximal extremities, head and neck, or trunk; and the use of myocutaneous flaps. This score assessed the risk for RBCTs with a sensitivity of 77%, a specificity of 81%, and an AUC of the ROC curve of 0.86.ConclusionWe were able to develop a risk score that allows for the assessment of RBCT likelihood. While most of the identified risk factors cannot be prevented or corrected, it still allows for improved patient counseling and can potentially reduce the number of ordered but not transfused RBCTs.
authors.affiliation: Department of Plastic, Reconstructive and Esthetic Surgery, Handsurgery, Martin-Luther-Hospital, Berlin, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Kolbenschlag
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, Ruhr University, BG University Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, Ruhr University, BG University Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Kamran
authors.initials: K
authors.lastname: Harati
authors.affiliation: Department of Plastic, Reconstructive and Esthetic Surgery, Handsurgery, Martin-Luther-Hospital, Berlin, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Goertz
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Ruprechts-Karl-University Heidelberg, BG Trauma Center, Ludwigshafen, Germany.
authors.forename: Jochen Frederik
authors.initials: JF
authors.lastname: Hernekamp
authors.affiliation: Institute for Clinical Chemistry, Transfusion and Laboratory Medicine, Ruhr University, BG University Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Kempf
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, Ruhr University, BG University Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lehnhardt
authors.affiliation: Department of Plastic and Hand Surgery, Burn Center, Ruhr University, BG University Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hirsch
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome