Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Oral Oncol. 2023 Aug;143:106461. doi: 10.1016/j.oraloncology.2023.106461. Epub 2023 Jun 16.
This study sought to analyze the effects of perioperative blood transfusions and vasopressors on 30-day surgical complications and 1-year mortality after reconstructive surgery in head and neck free tissue transfer (FTT) and to identify predictors of administration of perioperative blood transfusions or vasopressors.
TriNetX (TriNetX LLC, Cambridge, USA), an international population-level electronic health record database, was queried to identify subjects that underwent FTT requiring perioperative (intraoperative to postoperative day 7) vasopressors or blood transfusions. Primary dependent variables were 30-day surgical complications and 1-year mortality. Propensity score matching was used to control for population differences, and covariate analysis was used to identify preoperative comorbidities associated with perioperative vasopressor or transfusion requirements.
7,631 patients met inclusion criteria. Preoperative malnutrition was associated with increased odds of perioperative transfusion (p = 0.002) and vasopressor requirement (p < 0.001). Perioperative blood transfusion (n = 941) was associated with increased odds of any surgical complication (p = 0.041) within 30 days postoperatively and specifically increased odds of wound dehiscence (p = 0.008) and FTT failure (p = 0.002), respectively. Perioperative vasopressor was (n = 197) was not associated with 30-day surgical complications. Vasopressor requirement was associated with increased hazards-ratio of mortality at 1-year (p = 0.0031).
Perioperative blood transfusion in FTT is associated with increased odds for surgical complications. Judicious use as a hemodynamic support measure should be considered. Perioperative vasopressor use was associated with an increased risk of one-year mortality. Malnutrition is a modifiable risk factor for perioperative transfusion and vasopressor requirement. These data warrant further investigation to assess causation and potential opportunity for practice improvement.
本研究旨在分析头颈部游离组织移植（FTT）围手术期输血和血管加压药对 30 天手术并发症和 1 年死亡率的影响，并确定围手术期输血或血管加压药使用的预测因素。
使用 TriNetX（TriNetX LLC，美国剑桥），一个国际人群水平的电子健康记录数据库，查询需要围手术期（术中至术后第 7 天）血管加压药或输血的 FTT 患者。主要的依赖变量是 30 天手术并发症和 1 年死亡率。使用倾向评分匹配来控制人群差异，使用协变量分析来确定与围手术期血管加压药或输血需求相关的术前合并症。
7631 名患者符合纳入标准。术前营养不良与围手术期输血（p=0.002）和血管加压药需求（p<0.001）的几率增加相关。围手术期输血（n=941）与术后 30 天内任何手术并发症的几率增加相关（p=0.041），特别是与伤口裂开（p=0.008）和 FTT 失败（p=0.002）的几率增加相关。围手术期血管加压药（n=197）与 30 天手术并发症无关。血管加压药的需求与 1 年死亡率的危险比增加相关（p=0.0031）。
FTT 中的围手术期输血与手术并发症的几率增加相关。应考虑将其作为一种血流动力学支持措施的合理使用。围手术期血管加压药的使用与 1 年死亡率的风险增加相关。营养不良是围手术期输血和血管加压药需求的可改变的危险因素。这些数据需要进一步研究，以评估因果关系和潜在的实践改进机会。
