Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107th Yanjiang Xi Road, Guangzhou, 510120, Guangdong, China.
First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
BMC Oral Health. 2022 Aug 1;22(1):322. doi: 10.1186/s12903-022-02357-1.
We established a MSBOS for flap reconstruction in oral and maxillofacial cancer patients.
We enrolled 2080 cases of oral and maxillofacial flap reconstruction from January 1, 2010 to December 31, 2021. Patient data were collected, including age, sex, BMI, preoperative Hb levels, ASA grade, T stage, flap type, tumor location, and bone flap. Scoring criteria were established based on a multivariate model of independent risk variables and their odds ratios. Two flap-type groups were divided into low-risk, intermediate-risk and high-risk groups by the scoring criteria, and analyzed using univariate and multivariate logistic regression. Perioperative transfusion analysis identified independent risk factors at various Hb levels. The cumulative percentage of patients requiring perioperative blood transfusion for each surgical procedure was calculated to establish the MSBOS.
(1) Regression analysis showed that BMI, tumor T staging, ASA grade, preoperative Hb level (male: Hb < 130 g/L, female: Hb < 120 g/L), and bone flap were independent risk factors for perioperative blood transfusion. (2) Regression analysis showed that independent risk factors for perioperative transfusion included the following: BMI, tumor T3-T4 stage, ASA III, IV grade, and free flap/pediculated flap/bone flap in patients with different Hb levels; T3-T4 stage, ASA grade III-IV in mildly anemic patients; and ASA grade III-IV in moderately anemic patients. (3) A MSBOS was established for flap reconstruction in head and neck cancer patients.
A MSBOS for head and neck cancer procedures was reduced by approximately 30% perioperative blood preparation while ensuring that clinical blood use standards were met. It help optimize blood inventory, and save blood resources.
我们建立了一个用于口腔颌面癌患者皮瓣重建的 MSBOS。
我们纳入了 2080 例 2010 年 1 月 1 日至 2021 年 12 月 31 日期间口腔颌面皮瓣重建患者。收集患者数据，包括年龄、性别、BMI、术前 Hb 水平、ASA 分级、T 分期、皮瓣类型、肿瘤位置和骨瓣。基于独立风险变量及其比值比的多变量模型建立评分标准。根据评分标准，将两种皮瓣类型的患者分为低危、中危和高危组，采用单因素和多因素逻辑回归进行分析。围手术期输血分析确定了不同 Hb 水平的独立危险因素。计算每个手术程序需要围手术期输血的患者累积百分比，以建立 MSBOS。
（1）回归分析显示 BMI、肿瘤 T 分期、ASA 分级、术前 Hb 水平（男性：Hb<130 g/L，女性：Hb<120 g/L）和骨瓣是围手术期输血的独立危险因素。（2）回归分析显示，围手术期输血的独立危险因素包括：不同 Hb 水平患者的 BMI、肿瘤 T3-T4 分期、ASA III、IV 级和游离皮瓣/带蒂皮瓣/骨瓣；轻度贫血患者的 T3-T4 分期、ASA III-IV 级；中度贫血患者的 ASA III-IV 级。（3）建立了头颈部癌患者皮瓣重建的 MSBOS。
在保证临床用血标准的前提下，MSBOS 减少了头颈部癌手术约 30%的围手术期备血，有助于优化血液库存，节约血液资源。
