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Țichil I, Țichil T, Haplea IS, Tomuleasa CI, Fodor L, Mitre I. Predictors for anaemia, blood transfusion and outcome in plastic surgery patients. J Int Med Res 2024; 52:3000605241237720. [PMID: 38506344 PMCID: PMC10956162 DOI: 10.1177/03000605241237720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE In patients undergoing plastic surgery, to identify specific risk factors for anaemia and use of blood products, and assess their impact on patient outcome. METHOD For this retrospective study, data were analysed from patients who attended the Plastic Surgery Department at our hospital over a three-year period (2018 to 2020). Adult patients who presented with traumatic injuries, oncologic patients who underwent reconstructive procedures, and patients with soft tissue infections (STIs) who required plastic surgery for tissue coverage were included. Demographic and injury data, hospital admission characteristics, surgical procedures, laboratory test results, transfusion events, and in-hospital complications were extracted from patient records. RESULTS Of the 350 patients included in the study, 228 (65%) presented with trauma, 76 (22%) underwent reconstructive surgery for cancers and 46 (13%) had STIs. In total, 175 (50%) patients developed anaemia, and 37 (11%) received blood transfusions; these were 20 (54%), 5 (14%), and 12 (32%) patients in the trauma, cancer and STI groups, respectively. Associated comorbidities and upper and lower limb surgery were the most significant risk factors for anaemia, while the number of surgeries and NSTIs were identified as risk factors for blood transfusions. Direct wound closure was consistently a protective factor for both anaemia and blood transfusions. Blood transfusions were independently associated with a high risk of sepsis, wound complications, and prolonged hospital stay. CONCLUSION While transfusions are necessary and even lifesaving in surgical patients, blood is a finite resource and its use may negatively impact patient outcome. Therefore, ongoing research must focus on providing safe and restrictive clinical practices while developing sustainable and accessible alternatives.
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Affiliation(s)
- Ioana Țichil
- University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj Napoca, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- Emergency County Hospital, 3–5 Clinicilor Street, 400006, Cluj-Napoca, Romania
- Department of Haematology “Ion Chiricuta” Institute of Oncology 34–36 Republicii Street, Cluj-Napoca, 400015, Romania
| | - Teodora Țichil
- Emergency County Hospital, 3–5 Clinicilor Street, 400006, Cluj-Napoca, Romania
- Opticlinic Med – Eye Care Center 13–15 Bucegi Street, Cluj-Napoca, 400535, Romania
| | - Ionuț Stefan Haplea
- University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj Napoca, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
| | - Ciprian Ionuț Tomuleasa
- University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj Napoca, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- Department of Haematology “Ion Chiricuta” Institute of Oncology 34–36 Republicii Street, Cluj-Napoca, 400015, Romania
| | - Lucian Fodor
- Emergency County Hospital, 3–5 Clinicilor Street, 400006, Cluj-Napoca, Romania
| | - Ileana Mitre
- University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj Napoca, 8 Victor Babes Street, 400012, Cluj-Napoca, Romania
- Emergency County Hospital, 3–5 Clinicilor Street, 400006, Cluj-Napoca, Romania
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Ali M, Dort JC, Sauro KM. Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2023; 52:3. [PMID: 36691071 PMCID: PMC9872343 DOI: 10.1186/s40463-022-00588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND There is a growing concern with inappropriate, excessive perioperative blood transfusions. Understanding the influence of low preoperative hemoglobin (Hgb) on perioperative blood transfusion (PBT) in head and neck cancer (HNC) surgery with free flap reconstruction may help guide clinical practice to reduce inappropriate treatment among these patients. The objective is to synthesize evidence regarding the association between preoperative Hgb and PBT among major HNC free flap surgeries. METHODS Terms and synonyms for HNC surgical procedures, Hgb and PBT were used to search MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Reviews from inception to February 2020. Reference lists of included full texts and studies reporting the preoperative Hgb, anemia or hematocrit (exposure) and the PBT (outcome) in major HNC surgery with free flap reconstruction were eligible. Studies examining esophageal, thyroid and parathyroid neoplasms were excluded; as were case reports, case series (n < 20), editorials, reviews, perspectives, viewpoints and responses. Two independent, blinded reviewers screened titles, abstracts and full texts in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. A random-effects model was used to pool reported data. The primary outcome was the proportion of patients who had a PBT. Subgroup analysis examined sources of heterogeneity for perioperative predictors of PBT (age, sex, flap type, flap site and preoperative Hgb). We also examined mean preoperative Hgb in the PBT and no PBT groups. RESULTS Patients with low preoperative Hgb were transfused more than those with normal Hgb (47.62%, 95% CI = 41.19-54.06, I2 = 0.00% and 13.92%, 95% CI = 10.19-17.65, I2 = 20.69%, respectively). None of the predictor variables explained PBT. The overall pooled mean preoperative Hgb was 12.96 g/dL (95% CI = 11.33-14.59, I2 = 0.00%) and was 13.58 g/dL (95% CI = 11.95-15.21, I2 = 0.00%) in the no PBT group and 12.05 g/dL (95% CI = 10.01 to 14.09, I2 = 0.00%) in the PBT group. CONCLUSIONS The heterogeneity between studies, especially around the trigger for PBT, highlights the need for additional research to guide clinical practice of preoperative Hgb related to PBT to enhance patient outcomes and improve healthcare stewardship.
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Affiliation(s)
- Munib Ali
- grid.22072.350000 0004 1936 7697Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Ohlson Research Initiative, University of Calgary, Calgary, AB Canada
| | - Joseph C. Dort
- grid.22072.350000 0004 1936 7697Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Ohlson Research Initiative, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Oncology, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Surgery, University of Calgary, Calgary, AB Canada
| | - Khara M. Sauro
- grid.22072.350000 0004 1936 7697Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Ohlson Research Initiative, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Oncology, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Surgery, University of Calgary, Calgary, AB Canada
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Spillinger A, Allen M, Karabon P, Hojjat H, Shenouda K, Hussein IH, Jacob JT, Svider PF, Folbe AJ. Cost-Effectiveness of Routine Type and Screens in Select Endonasal Skull Base Surgeries. Skull Base Surg 2022; 83:e449-e458. [DOI: 10.1055/s-0041-1730896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Objective The study aimed to evaluate the cost-effectiveness of obtaining preoperative type and screens (T/S) for common endonasal skull base procedures, and determine patient and hospital factors associated with receiving blood transfusions.
Study Design Retrospective database analysis of the 2006 to 2015 National (nationwide) Inpatient Sample and cost-effectiveness analysis.
Main Outcome Measures Multivariate regression analysis was used to identify factors associated with transfusions. A cost-effectiveness analysis was then performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.
Results A total of 93,105 cases were identified with an overall transfusion rate of 1.89%. On multivariate modeling, statistically significant factors associated with transfusion included nonelective admission (odds ratio [OR]: 2.32; 95% confidence interval [CI]: 1.78–3.02), anemia (OR: 4.42; 95% CI: 3.35–5.83), coagulopathy (OR: 4.72; 95% CI: 2.94–7.57), diabetes (OR: 1.45; 95% CI: 1.14–1.84), liver disease (OR: 2.37; 95% CI: 1.27–4.43), pulmonary circulation disorders (OR: 3.28; 95% CI: 1.71–6.29), and metastatic cancer (OR: 5.85; 95% CI: 2.63–13.0; p < 0.01 for all). The ICER of preoperative T/S was $3,576 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S.
Conclusion Routine preoperative T/S does not represent a cost-effective practice for these surgeries using nationally representative data. A selective T/S policy for high-risk patients may reduce costs.
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Affiliation(s)
- Aviv Spillinger
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States
- Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
| | - Meredith Allen
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States
- Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
| | - Patrick Karabon
- Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
| | - Houmehr Hojjat
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Kerolos Shenouda
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Inaya Hajj Hussein
- Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
| | - Jeffrey T. Jacob
- Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan, United States
| | - Peter F. Svider
- Department of Otolaryngology, Hackensack University Medical Center, Hackensack, New Jersey, United States
| | - Adam J. Folbe
- Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan, United States
- Office of Research, Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, United States
- Department of Otolaryngology—Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
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Pai K, Baaklini C, Cabrera CI, Tamaki A, Fowler N, Maronian N. The Utility of Comorbidity Indices in Assessing Head and Neck Surgery Outcomes: A Systematic Review. Laryngoscope 2021; 132:1388-1402. [PMID: 34661923 DOI: 10.1002/lary.29905] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the utility of comorbidity index (CI) scores in predicting outcomes in head and neck surgery (HNS). The CIs evaluated were the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Kaplan-Feinstein Index (KFI), American Society of Anesthesiologists Physical Status (ASA-PS), Adult Comorbidity Evaluation-27 (ACE-27), National Cancer Institute Comorbidity Index (NCI-CI), and the Washington University Head and Neck Comorbidity Index (WUHNCI). METHODS We report a systematic review according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, and Embase) and manual search of bibliographies identified manuscripts addressing how CI scores related to HNS outcomes. RESULTS A total of 116 studies associated CI scores with HNS outcomes. CIs were represented in the literature as follows: ASA-PS (70/116), CCI (39/116), ACE-27 (24/116), KFI (7/116), NCI-CI (3/116), ECI (2/116), and WUHNCI (1/116). The most frequently cited justification for calculating each CI (if provided) was: CCI for its validation in other studies, ACE-27 for its utility in cancer patients, and ECI for its comprehensive design. In general, the CCI and ACE-27 were predictive of mortality in HNS. The ECI was most consistent in predicting >1-year mortality. The ACE-27 and KFI were most consistent in predicting medical complications. CONCLUSION Despite inconsistencies in the literature, CIs provide insights into the impact of comorbidities on outcomes in HNS. These scores should be employed as an adjunct in the preoperative assessment of HNS patients. Comparative studies are needed to identify indices that are most reliable in predicting HNS outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 2021.
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Affiliation(s)
- Kavya Pai
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, U.S.A
| | - Carla Baaklini
- Northeast Ohio Medical University, Rootstown, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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Su JQ, Xie S, Cai ZG, Wang XY. Developing a predictive risk score for perioperative blood transfusion: a retrospective study in patients with oral and oropharyngeal squamous cell carcinoma undergoing free flap reconstruction surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:854. [PMID: 34164488 PMCID: PMC8184453 DOI: 10.21037/atm-21-1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background A simple and accurate scoring system to predict risk of blood transfusion in patients having surgical tumor resection with immediate free flap reconstruction primary surgery for oral and oropharyngeal squamous cell carcinoma (OOSCC) is lacking. Anticipating the blood transfusion requirements in patients with oral cancer is of great clinical importance. This research aimed to propose a valid model to predict transfusion requirements in patients undergoing surgery with free flap reconstruction for an OOSCC. Methods This retrospective study consisted of 385 patients who underwent oncologic surgery with immediate free flap reconstruction for locally advanced OOSCC from 2012 to 2019. The primary outcome measured was the exposure of patients to perioperative allogeneic blood transfusion. Based on a multivariate model of independent risk variables and their odds ratio, a blood transfusion risk score (TRS) was developed to predict the likelihood of the perioperative blood transfusion. The discriminatory accuracy of the model was evaluated using the area under the receiver operating characteristic (ROC) curve, and Youden index was used to identify the optimal cut-point. Results Logistic regression analyses identified lymph node status, preoperative hemoglobin (Hb) levels, bone resection, osseous free tissue transfer, and operative duration were identified as independent predictors of blood transfusion. A TRS integrating these variables was separated into three categories. The TRS assessed the transfusion risk with good predictive ability, with an overall area under the ROC curve (AUC) was 0.826. At the optimal cut-point of 5.5, the TRS had a sensitivity of 72.3% and a specificity of 78.2%. The ROC analysis showed that patients with a TRS of 5.5 or more had a greater requirement for perioperative transfusion. Conclusions The use of the integer-based TRS allowed the identification of high-risk patients who may require perioperative transfusion undergoing tumor resection surgery for the treatment of OOSCC.
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Affiliation(s)
- Jun-Qi Su
- Department of Clinical Laboratory, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiao-Ying Wang
- Department of Medical Record, Peking University School and Hospital of Stomatology, Beijing, China
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Walczak S, Velanovich V. Prediction of perioperative transfusions using an artificial neural network. PLoS One 2020; 15:e0229450. [PMID: 32092108 PMCID: PMC7039514 DOI: 10.1371/journal.pone.0229450] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/06/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Accurate prediction of operative transfusions is essential for resource allocation and identifying patients at risk of postoperative adverse events. This research examines the efficacy of using artificial neural networks (ANNs) to predict transfusions for all inpatient operations. METHODS Over 1.6 million surgical cases over a two year period from the NSQIP-PUF database are used. Data from 2014 (750937 records) are used for model development and data from 2015 (885502 records) are used for model validation. ANN and regression models are developed to predict perioperative transfusions for surgical patients. RESULTS Various ANN models and logistic regression, using four variable sets, are compared. The best performing ANN models with respect to both sensitivity and area under the receiver operator characteristic curve outperformed all of the regression models (p < .001) and achieved a performance of 70-80% specificity with a corresponding 75-62% sensitivity. CONCLUSION ANNs can predict >75% of the patients who will require transfusion and 70% of those who will not. Increasing specificity to 80% still enables a sensitivity of almost 67%. The unique contribution of this research is the utilization of a single ANN model to predict transfusions across a broad range of surgical procedures.
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Affiliation(s)
- Steven Walczak
- School of Information, Florida Center for Cybersecurity, University of South Florida, Tampa, FL, United States of America
| | - Vic Velanovich
- Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, United States of America
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Rogers SN, Horisk K, Groom P, Lowe D. Management of anaemia and blood in patients having neck dissections or free flaps for head and neck cancer. Br J Oral Maxillofac Surg 2019; 57:543-549. [PMID: 31128950 DOI: 10.1016/j.bjoms.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 05/02/2019] [Indexed: 01/19/2023]
Abstract
Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review which patients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients between October 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients had soft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition of anaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. The median (IQR) Hb at discharge was 131 (119-144) g/L for patients who had neck dissections, 103 (95-114) g/L for those who had soft free flaps, and 95 (90-104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC) transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39 transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patients were given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) given iron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acid and of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperative incidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.
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Affiliation(s)
- S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St. Helens Road, Ormskirk L39 4QP; Consultant, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK.
| | - K Horisk
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, UK.
| | - P Groom
- University Hospital Aintree, Liverpool L9 1AE, UK.
| | - D Lowe
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk L39 4QP.
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Azmy MC, Pinto J, Patel NM, Govindan A, Kalyoussef E. Risk Factors for Blood Transfusion with Neck Dissection. Otolaryngol Head Neck Surg 2019; 161:922-928. [PMID: 30935286 DOI: 10.1177/0194599819839946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To identify risk factors of perioperative blood transfusions (PBTs) for neck dissection and identify the association of PBTs with other postoperative outcomes. METHODS This is a retrospective study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The database was queried for neck dissection procedures performed by otolaryngologists from 2006 to 2014. Multivariable logistic regression was used to determine associations between demographic and preoperative factors, mortality, unplanned reoperation, and unplanned readmission with PBTs. RESULTS Of the 3090 patients included in our study, 346 (11.2%) received a PBT, 249 patients (72.0%) received blood intraoperatively or on postoperative day (POD) 0, and 97 patients (28.0%) received blood within 5 PODs. American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4-3.2), preoperative weight loss (OR, 2.2; 95% CI, 1.5-3.2), and anemia (OR, 5.5; 95% CI, 4.1-7.6) were independently associated with PBTs. Free flaps were also significantly associated with PBTs. PBTs were significantly associated with unplanned return to the operating room within 30 days (OR, 4.31; 95% CI, 3.01-6.18) but not with 30-day unplanned readmission or 30-day mortality. DISCUSSION Eleven percent of patients undergoing neck dissection receive a PBT. Identifying associated risk factors may reduce PBT among patients with cancer. Comorbid data, such as weight loss, anemia, and ASA class, may be useful in determining risk for transfusion during these procedures. IMPLICATIONS FOR PRACTICE Awareness of preoperative risk factors for PBT may lead surgeons to reduce the risk of PBT, anticipate the need for transfusion, and manage these patients carefully to prevent unplanned reoperation.
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Affiliation(s)
- Monica C Azmy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Juanita Pinto
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Nirali M Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Aparna Govindan
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Evelyne Kalyoussef
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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