Head and Neck Cancer (HNC) surgery
Bleeding and subsequent RBC transfusions are relatively common in major
HNC surgery. Goel et al. found a 5.4% incidence rate of bleeding and
post-operative transfusion within 72 hours.8 In our
non-epistaxis related RBC transfusion patient cohort, major HNC surgery
with and without reconstruction (n=20) made up 58.8% of post-operative
blood transfusions and 25.1% of overall blood transfusions over the
study period. These results are reflected in the available literature
where one study identified 14% to 80% of patients undergoing major
Head and Neck surgery required allogeneic RBC
transfusions.7
Figure 3 shows HNC surgery without reconstruction required fewer units
than with reconstruction. Additionally, the total number of units
transfused declined with time and was statistically significant (P=0.01)
for HNC surgery without reconstruction.
Krupp et al. validated a transfusion prediction and risk assessment
(TPRA) model for a patient to receive a perioperative transfusion:
higher tumour stages, use of a flap and pre-operative anaemia were
associated with higher rates of peri-operative transfusions. This tool
allows clinicians to appropriately counsel patients on blood
transfusions and address pre-existing anaemias in the pre-operative
period.7 A similar model was also replicated by Shah
et al. who additionally found female sex, underweight BMI and osseous
free flap reconstructions also contributed to higher rates of
transfusion.6 However, these models have been shown to
predict peri-operative transfusion risk rather than post-operative
transfusion risk. Further research is required to identify if a similar
model can accurately predict post-operative transfusions in HNC patients
undergoing surgery. It is however our experience that this patient group
harbors risk factors such as low BMI, high tumour stage, and the use of
composite grafts in reconstructions.
On closer review of our HNC data, the majority of patients undergoing a
laryngectomy were for radio-recurrent disease. This in itself is a risk
factor as it is a procedure with higher morbidity compared with primary
laryngectomy due to the need for reconstruction, poor tissue quality and
unpredictable angiogenesis following radiotherapy.19In addition, our HNC surgery patients are either borderline or anaemic
prior to surgery, which could be secondary to the burden of their prior
cancer treatment.