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

Journal of Otolaryngology - Head & Neck Surgery

Original Research Article

Munib Ali¹  Khara M. Sauro²  Joseph C. Dort² 

[1] Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, T2N 4Z6, Calgary, AB, Canada;Ohlson Research Initiative, University of Calgary, Calgary, AB, Canada;Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, T2N 4Z6, Calgary, AB, Canada;Ohlson Research Initiative, University of Calgary, Calgary, AB, Canada;Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;Department of Oncology, University of Calgary, Calgary, AB, Canada;Department of Surgery, University of Calgary, Calgary, AB, Canada;

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

DOI  :  10.1186/s40463-022-00588-4

 received in 2022-01-28, accepted in 2022-07-18,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThere 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.MethodsTerms 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.ResultsPatients 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 ofthe 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.ConclusionsThe 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.Graphical abstract

【 授权许可】

CC BY   
© The Author(s) 2023

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