Impact of Blood Transfusions on Patients With Head and Neck Cancer Undergoing Free Tissue Transfer

Objectives/HypothesisTo determine whether blood transfusions are associated with adverse outcomes in patients with head and neck cancer (HNC) undergoing microvascular free tissue transfer. Study DesignRetrospective cohort study. MethodsThe 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. ResultsOf 167 patients, 90 received 0 to 2 units of blood and 77 received3. After controlling for age, preoperative hemoglobin, preoperative albumin, cancer stage, and adverse pathologic features, transfusion of3 (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, or3 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 versus2 units (P=0.04). ConclusionsPatients who receive3 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. Level of Evidence2b. Laryngoscope, 125:86-91, 2015