Anaemia and patient blood management in patients having neck dissections or free flaps for head and neck cancer

SIMON ROGERS, Derek Lowe, K Horisk, Peter Groom

Research output: Contribution to journalArticle

Abstract

Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition ofanaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.
Original languageEnglish
JournalBritish Journal of Oral and Maxillofacial Surgery
Early online date23 May 2019
Publication statusE-pub ahead of print - 23 May 2019

Fingerprint

Neck Dissection
Free Tissue Flaps
Head and Neck Neoplasms
Anemia
Hemoglobins
Blood Transfusion
Guidelines
Tranexamic Acid
Erythrocyte Transfusion
Fatigue
Iron
Quality of Life

Keywords

  • Anaemia;
  • Blood Transfusion
  • Neck dissection
  • Audit

Cite this

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title = "Anaemia and patient blood management in patients having neck dissections or free flaps for head and neck cancer",
abstract = "Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26{\%} had composite free flaps (n = 34), and 24{\%} neck dissection only (n = 32). Using the WHO definition ofanaemia, 4{\%} (1/28) of patients who had neck dissections and 19{\%} (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26{\%}) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79{\%}). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24{\%}) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.",
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Anaemia and patient blood management in patients having neck dissections or free flaps for head and neck cancer. / ROGERS, SIMON; Lowe, Derek; Horisk, K; Groom, Peter.

In: British Journal of Oral and Maxillofacial Surgery, 23.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anaemia and patient blood management in patients having neck dissections or free flaps for head and neck cancer

AU - ROGERS, SIMON

AU - Lowe, Derek

AU - Horisk, K

AU - Groom, Peter

PY - 2019/5/23

Y1 - 2019/5/23

N2 - Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition ofanaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.

AB - Our main aims were to assess haemoglobin (Hb) concentrations from preoperative assessment to discharge from hospital, and to review whichpatients had blood transfusions and compliance with national transfusion guidelines. We studied a consecutive series of 131 patients betweenOctober 2016 and September 2017 who had either neck dissection or resection and free microvascular tissue transfer. Half the patients hadsoft tissue free flaps (n = 65), 26% had composite free flaps (n = 34), and 24% neck dissection only (n = 32). Using the WHO definition ofanaemia, 4% (1/28) of patients who had neck dissections and 19% (16/85) of those who had free flaps were anaemic preoperatively. Themedian (IQR) Hb at discharge was 131 (119–144) g/L for patients who had neck dissections, 103 (95–114) g/L for those who had soft freeflaps, and 95 (90–104) g/L for those who had composite free flaps. No patients who had neck dissection were given a red blood cell (RBC)transfusion, whereas they were given to 26/99 (26%) of those who had free flaps. Hb concentrations were checked after each unit in 31/39transfusions (79%). Concentrations for those who had free flaps fell by about 30 g/L from admission to operation, and only four patientswere given tranexamic acid peroperatively. Postoperatively Hb remained at similar concentrations until discharge, with 23/98 (24%) giveniron orally on discharge. In terms of compliance with blood transfusion guidelines there was a notable absence of the use of tranexamic acidand of iron intravenously. An increase in their use could potentially reduce the number of blood transfusions required and the postoperativeincidence of anaemia, and have a favourable effect on outcomes such as complications, fatigue, and overall quality of life.

KW - Anaemia;

KW - Blood Transfusion

KW - Neck dissection

KW - Audit

M3 - Article

JO - British Journal of Oral and Maxillofacial Surgery

JF - British Journal of Oral and Maxillofacial Surgery

SN - 0266-4356

ER -