Association between blood transfusion and outcomes of free flap head and neck cancer surgery

Objective: Investigate the impact of patient risk factors and blood transfusions in Head and Neck free flap surgeries. Study design: Retrospective chart review. Setting: Single tertiary referral center. Methods: 400 patients were included undergoing free flap reconstruction from 2014 to 2020. The primary outcome measures were red blood cell transfusion and volume transfused. Race, sex, flap location and tissue type, pathology, dependent functional status, length of stay, and cancer recurrence were evaluated for association with red blood cell transfusion intraoperatively and/or postoperatively. Transfusions were indicated on patients with Hemoglobin <7-8 and/or symptomatic anemia. ANOVA and Chi(2) statistical analysis were performed. The significance was set at p <= 0.05. Results: Of the 400 patients included, 58 required red blood cell transfusion. Of these 67.8 % were males, racial demographics included 9.00 % African American, 1.30 % Asian, 1.00 % Hispanic/Latino, 87.8 % White, 1.00 % other. African American patients received a higher volume of transfused red blood cells versus white patients (855.00 mL vs. 437.07 mL, p = 0.005). Length of stay was significantly associated with red blood cell transfusion (5.95 days vs. 7.22 days, p <= 0.001). Dependent functional status and need for red blood cell transfusion were associated (p = 0.002). Type of free flap was associated with need for red blood cell transfusion (p <= 0.001) with anterolateral thigh flaps being the most common resulting in transfusion (34/58). Conclusion: Red blood cell transfusion was significantly associated with race, dependent functional status and length of stay. Certain free flaps have a higher risk of blood transfusion.