Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Jan 24;52(1):3.
doi: 10.1186/s40463-022-00588-4.

Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: a systematic review and meta-analysis

Munib Ali  1   2 , Joseph C Dort #  1   2   3   4   5 , Khara M Sauro #  6   7   8   9   10
Affiliations
Meta-Analysis

Preoperative hemoglobin and perioperative blood transfusion in major head and neck surgery: a systematic review and meta-analysis

Munib Ali et al. J Otolaryngol Head Neck Surg. .

Abstract

Background: There is a growing concern with inappropriate, excessive perioperative blood transfusions. Understanding the influence of low preoperative hemoglobin (Hgb) on perioperative blood transfusion (PBT) in head and neck cancer (HNC) surgery with free flap reconstruction may help guide clinical practice to reduce inappropriate treatment among these patients. The objective is to synthesize evidence regarding the association between preoperative Hgb and PBT among major HNC free flap surgeries.

Methods: Terms and synonyms for HNC surgical procedures, Hgb and PBT were used to search MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Reviews from inception to February 2020. Reference lists of included full texts and studies reporting the preoperative Hgb, anemia or hematocrit (exposure) and the PBT (outcome) in major HNC surgery with free flap reconstruction were eligible. Studies examining esophageal, thyroid and parathyroid neoplasms were excluded; as were case reports, case series (n < 20), editorials, reviews, perspectives, viewpoints and responses. Two independent, blinded reviewers screened titles, abstracts and full texts in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. A random-effects model was used to pool reported data. The primary outcome was the proportion of patients who had a PBT. Subgroup analysis examined sources of heterogeneity for perioperative predictors of PBT (age, sex, flap type, flap site and preoperative Hgb). We also examined mean preoperative Hgb in the PBT and no PBT groups.

Results: Patients with low preoperative Hgb were transfused more than those with normal Hgb (47.62%, 95% CI = 41.19-54.06, I2 = 0.00% and 13.92%, 95% CI = 10.19-17.65, I2 = 20.69%, respectively). None of the predictor variables explained PBT. The overall pooled mean preoperative Hgb was 12.96 g/dL (95% CI = 11.33-14.59, I2 = 0.00%) and was 13.58 g/dL (95% CI = 11.95-15.21, I2 = 0.00%) in the no PBT group and 12.05 g/dL (95% CI = 10.01 to 14.09, I2 = 0.00%) in the PBT group.

Conclusions: The heterogeneity between studies, especially around the trigger for PBT, highlights the need for additional research to guide clinical practice of preoperative Hgb related to PBT to enhance patient outcomes and improve healthcare stewardship.

Keywords: Blood transfusion; ENT; Ears nose throat; Free flap reconstruction; Free tissue transfer; Head and neck cancer; Head and neck carcinoma; Head and neck neoplasms; Head and neck surgery; Meta-analysis; Otolaryngology; Otorhinolaryngology; Preoperative anemia; Systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Meta-analysis of preoperative Hgb (g/dL) and subgroup analysis for patients who did not have a perioperative blood transfusion (PBT) and those who did. Hgb, hemoglobin in grams per decaliter; PBT, perioperative blood transfusion
Fig. 3
Fig. 3
Post-operative blood transfusion by subgroups
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist. 2010;15(9):994–1001. doi: 10.1634/theoncologist.2009-0289. - DOI - PMC - PubMed
    1. Sanderson RJ, Ironside JAD. Squamous cell carcinomas of the head and neck. BMJ. 2002;325(7368):822–827. doi: 10.1136/bmj.325.7368.822. - DOI - PMC - PubMed
    1. Kim L, King T, Agulnik M. Head and neck cancer: changing epidemiology and public health implications. Oncology. 2010;24(10):915. - PubMed
    1. Pezzuto F, Buonaguro L, Caponigro F, et al. Update on head and neck cancer: current knowledge on epidemiology, risk factors molecular features and novel therapies. Oncology. 2015;89(3):125–136. doi: 10.1159/000381717. - DOI - PubMed