Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery

[摘要] 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 2 /m 2 ), 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 ( P = .035), more frequent alcoholism ( P = .028) and sarcopenia ( P  < .001), greater mCCI ( P  < .001), lower preoperative hemoglobin ( P  < .001), reconstruction with flaps other than forearm ( P = .003), and greater operative times ( P = .001), intravenous fluids ( P  < .001), and estimated blood loss (EBL, P  < .001). Postoperative transfusions were associated with major complications (CD ≥ 3; P  < .001). Multivariate regression determined sarcopenia ( P = .023), mCCI ( P = .013), preoperative hemoglobin ( P = .002), operative time ( P = .036), and EBL ( P  < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin ( P = .007), osseous flap ( P = .036), and CD ≥ 3 ( P  < .001). A perioperative transfusion was predicted by sarcopenia ( P = .021), preoperative hemoglobin ( P  < .001), operative time ( P = .008), and CD ≥ 3 ( P = .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 4.

[学科分类] 环境科学（综合）

[关键词] blood transfusion;free flap reconstruction;head and neck cancer;sarcopenia;skeletal muscle index