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| Main Authors: | , , , , , , , , , |
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| Format: | Artículo Open Access |
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Wiley
2024
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| Online Access: | https://onlinelibrary.wiley.com/doi/10.1002/lio2.70021 |
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| author | Osama A. Hamdi Deepa Danan Amber Denner Jeffrey R. Bellinger Noah Thornton David C. Shonka Jonathan C. Garneau Katherine Fedder Mark J. Jameson Eric M. Dowling |
| author_facet | Osama A. Hamdi Deepa Danan Amber Denner Jeffrey R. Bellinger Noah Thornton David C. Shonka Jonathan C. Garneau Katherine Fedder Mark J. Jameson Eric M. Dowling Osama A. Hamdi Deepa Danan Amber Denner Jeffrey R. Bellinger Noah Thornton David C. Shonka Jonathan C. Garneau Katherine Fedder Mark J. Jameson Eric M. Dowling |
| collection | Wiley Open Access |
| contents | Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer Osama A. Hamdi Deepa Danan Amber Denner Jeffrey R. Bellinger Noah Thornton David C. Shonka Jonathan C. Garneau Katherine Fedder Mark J. Jameson Eric M. Dowling Laryngoscope Investigative Otolaryngology AbstractObjectiveRecent literature studying the impact of blood transfusion on outcomes in patients with head and neck cancer (HNC) have shown that blood transfusions are associated with increased risk of death and higher wound infection rates. The purpose of this study was to implement a lower transfusion threshold while comparing outcomes of free flap patients following initiation of a new transfusion guideline.MethodsA retrospective study of all patients at a tertiary care academic center who underwent free tissue transfer after HNC resection between July 17, 2007 and June 7, 2021. Transfusion criteria were adjusted in 2014; the hematocrit threshold to transfuse was incrementally reduced from 30% in 2007 to 21% in 2017. The main outcomes of interest were overall survival (OS) and recurrence free survival (RFS).ResultsA total of 346 patients met the criteria for inclusion in the study. Groups 1 (less strict protocol – 30%) and 2 (stricter protocol – 21%) consisted of 171 and 175 patients, respectively. Fewer units of packed red cells were transfused per patient in group 2 (0.26 vs. 2.87 in group 1, p < .001). Group 1 was associated with worse OS (p = .01; hazard ratio [HR] = 1.7) and RFS (p < .001; HR = 2.5). Comparing only patients with SCC between the two groups also demonstrated poorer OS (p = .01; HR = 1.8) and RFS (p = .006; HR = 2.1) in group 1.ConclusionIn HNC patients undergoing free tissue transfer, stricter transfusion criteria with threshold hematocrit of 21% was associated with improved OS, RFS, and complication rates with no negative impact on free flap survival.Level of EvidenceLevel IV. 10.1002/lio2.70021 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1002/lio2.70021 |
| format | Artículo Open Access |
| id | wiley_oa_10_1002_lio2_70021 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2024 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer Osama A. Hamdi Deepa Danan Amber Denner Jeffrey R. Bellinger Noah Thornton David C. Shonka Jonathan C. Garneau Katherine Fedder Mark J. Jameson Eric M. Dowling Laryngoscope Investigative Otolaryngology Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer Osama A. Hamdi Deepa Danan Amber Denner Jeffrey R. Bellinger Noah Thornton David C. Shonka Jonathan C. Garneau Katherine Fedder Mark J. Jameson Eric M. Dowling Laryngoscope Investigative Otolaryngology AbstractObjectiveRecent literature studying the impact of blood transfusion on outcomes in patients with head and neck cancer (HNC) have shown that blood transfusions are associated with increased risk of death and higher wound infection rates. The purpose of this study was to implement a lower transfusion threshold while comparing outcomes of free flap patients following initiation of a new transfusion guideline.MethodsA retrospective study of all patients at a tertiary care academic center who underwent free tissue transfer after HNC resection between July 17, 2007 and June 7, 2021. Transfusion criteria were adjusted in 2014; the hematocrit threshold to transfuse was incrementally reduced from 30% in 2007 to 21% in 2017. The main outcomes of interest were overall survival (OS) and recurrence free survival (RFS).ResultsA total of 346 patients met the criteria for inclusion in the study. Groups 1 (less strict protocol – 30%) and 2 (stricter protocol – 21%) consisted of 171 and 175 patients, respectively. Fewer units of packed red cells were transfused per patient in group 2 (0.26 vs. 2.87 in group 1, p < .001). Group 1 was associated with worse OS (p = .01; hazard ratio [HR] = 1.7) and RFS (p < .001; HR = 2.5). Comparing only patients with SCC between the two groups also demonstrated poorer OS (p = .01; HR = 1.8) and RFS (p = .006; HR = 2.1) in group 1.ConclusionIn HNC patients undergoing free tissue transfer, stricter transfusion criteria with threshold hematocrit of 21% was associated with improved OS, RFS, and complication rates with no negative impact on free flap survival.Level of EvidenceLevel IV. 10.1002/lio2.70021 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer |
| topic | Laryngoscope Investigative Otolaryngology |
| url | https://onlinelibrary.wiley.com/doi/10.1002/lio2.70021 |