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. 2021 Jan 31;6(2):200-210.
doi: 10.1002/lio2.530. eCollection 2021 Apr.

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

Alexander Joseph Jones  1 , Vincent J Campiti  1 , Mohamedkazim Alwani  1 , Leah J Novinger  1 , Brady Jay Tucker  1 , Andrea Bonetto  2 , Jessica A Yesensky  1 , Michael W Sim  1 , Michael G Moore  1 , Avinash V Mantravadi  1
Affiliations

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

Alexander Joseph Jones et al. Laryngoscope Investig Otolaryngol. .

Abstract

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 (cm2/m2), 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.

Keywords: blood transfusion; free flap reconstruction; head and neck cancer; sarcopenia; skeletal muscle index.

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Conflict of interest statement

The authors declare no potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Axial CT comparison of a nonsarcopenic 47‐year‐old male with BMI of 21.0 kg/m2 and SMI of 60.1 cm2/m2 (A) and a sarcopenic 54‐year‐old male with BMI of 20.2 kg/m2 and SMI of 38.2 cm2/m2 (B). The highlighted areas indicate the isolated abdominal skeletal muscles at the third lumbar vertebra. BMI, body mass index; CT, computed tomography; SMI, skeletal muscle index
See this image and copyright information in PMC

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