Blood transfusion prediction in patients undergoing major head and neck surgery with free-flap reconstruction.

OBJECTIVE

to develop a clinically useful perioperative blood transfusion prediction model for patients undergoing a major head and neck surgical procedure requiring free-flap reconstruction.

DESIGN

retrospective observational study.

SETTING

tertiary care university-affiliated teaching hospital (University Health Network, Toronto, Ontario, Canada).

PATIENTS

all patients with a head and neck malignant neoplasm undergoing major head and neck surgery requiring free-flap reconstruction.

MAIN OUTCOME MEASURE

perioperative single-unit red blood cell transfusion.

RESULTS

all the preoperative variables were tested for an association with perioperative blood transfusion using univariable and multivariable analyses. After multivariable regression analysis, the following preoperative variables were found to be significantly associated with perioperative transfusion: sex, body mass index, T stage, preoperative hemoglobin level, and type of free-flap reconstruction used (ie, osseous vs nonosseous). The regression model was used to develop a transfusion risk score. Receiver operating characteristic curve analysis confirmed adequate discrimination of risk using the transfusion risk score.

CONCLUSIONS

we have developed a reliable model for predicting perioperative blood transfusion requirements in patients undergoing major head and neck surgery requiring free-flap reconstruction. This model can be used for accurate preoperative risk stratification.