Conclusion
Blood transfusions in ENT have decreased in our centre over the last five years in a specialty that already uses fewer transfusions in comparison to other surgical specialties. Epistaxis is amongst the commonest presentations in ENT requiring transfusing which is likely due to patient risk factors. HNC post-operative RBC use makes up 58.8% of the overall post-operative transfusion burden. This is likely owing to the increased complexity of cases as well as advanced tumour stages, requirement for a flap and pre-existing anaemia. The majority of the outliers (in terms of threshold for transfusion according to guidelines) in our subgroup analysis were related to flap reconstruction surgery despite growing evidence this may not result in patient benefit. The future involves a need for more rigorous prehabilitation programmes in ENT, the efficacy of which have been demonstrated across several surgical domains including general, cardiothoracic and orthopaedic surgery.25 In this current climate where optimising healthcare resources is essential, it is appropriate that thorough measures of pre-operative optimisation are implemented. This includes cost-effective supplementation with iron, folate and vitamin B12 to tackle pre-existing anaemia, which may reduce the need for blood transfusions. In addition, it may be necessary to revise highly selective individualised surgeon practices in order to optimise outcomes for our patients, reduce exposure to potential transfusion related morbidity and also further decrease the cost incurred to the health service.