肌少症与头颈癌游离皮瓣手术中的输血有关。
Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery.
作者信息
Jones Alexander Joseph, Campiti Vincent J, Alwani Mohamedkazim, Novinger Leah J, Tucker Brady Jay, Bonetto Andrea, Yesensky Jessica A, Sim Michael W, Moore Michael G, Mantravadi Avinash V
机构信息
Department of Otolaryngology-Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana USA.
Department of Surgery Indiana University School of Medicine Indianapolis Indiana USA.
出版信息
Laryngoscope Investig Otolaryngol. 2021 Jan 31;6(2):200-210. doi: 10.1002/lio2.530. eCollection 2021 Apr.
OBJECTIVE
To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR).
METHODS
A single-institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm/m), oncologic history, intraoperative data, and 30-day postoperative complications (Clavien-Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion.
RESULTS
Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty-two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age ( = .035), more frequent alcoholism ( = .028) and sarcopenia ( < .001), greater mCCI ( < .001), lower preoperative hemoglobin ( < .001), reconstruction with flaps other than forearm ( = .003), and greater operative times ( = .001), intravenous fluids ( < .001), and estimated blood loss (EBL, < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; < .001). Multivariate regression determined sarcopenia ( = .023), mCCI ( = .013), preoperative hemoglobin ( = .002), operative time ( = .036), and EBL ( < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin ( = .007), osseous flap ( = .036), and CD ≥ 3 ( < .001). A perioperative transfusion was predicted by sarcopenia ( = .021), preoperative hemoglobin ( < .001), operative time ( = .008), and CD ≥ 3 ( = .018).
CONCLUSION
Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource-limited scenarios.
LEVEL OF EVIDENCE
目的
确定肌肉减少症是否为头颈部癌游离皮瓣重建术（HNCFFR）中输血需求的预测指标。
方法
对2014年至2019年接受术前腹部影像学检查的HNCFFR患者进行单机构回顾性研究。收集人口统计学资料、合并症（改良Charlson合并症指数[mCCI]）、骨骼肌指数（cm/m）、肿瘤病史、术中数据及术后30天并发症（Clavien-Dindo评分[CD]）。采用二元逻辑回归分析确定输血的预测指标。
结果
239例患者中，分别有80例（33.5%）、66例（27.6%）和110例（46.0%）接受了术中、术后或围手术期输血。62例（25.9%）患者存在肌肉减少症。接受术中输血的患者年龄较大（P = .035）、酗酒更频繁（P = .028）且存在肌肉减少症（P < .001）、mCCI更高（P < .001）、术前血红蛋白水平更低（P < .001）、采用前臂以外的皮瓣进行重建（P = .003）、手术时间更长（P = .001）、静脉输液量更多（P < .001）以及估计失血量（EBL，P < .001）。术后输血与严重并发症（CD≥3；P < .001）相关。多因素回归分析确定肌肉减少症（P = .023）、mCCI（P = .013）、术前血红蛋白（P = .002）、手术时间（P = .036）和EBL（P < .001）为术中输血需求的独立预测指标。术前血红蛋白（P = .007）、骨皮瓣（P = .036）和CD≥3（P < .001）可预测术后输血情况。肌肉减少症（P = .021）、术前血红蛋白（P < .001）、手术时间（P = .008）和CD≥3（P = .018）可预测围手术期输血情况。
结论
肌肉减少症与HNCFFR中输血增加有关。应在术前向患者告知相关风险，在资源有限的情况下应考虑到血液制品需求增加的情况。
证据级别
4级。
Zotero 插件