Transfusion rates in oral squamous cell carcinoma patients undergoing free flap reconstruction in oral and maxillofacial surgery.

INTRODUCTION Oral squamous cell carcinoma (OSCC) frequently requires extensive resections and microvascular free flap reconstruction, procedures associated with relevant perioperative blood loss. This study aimed to quantify transfusion rates in OSCC patients and identify procedure- and patient-specific predictors of transfusion to guide evidence-based patient blood management (PBM).

MATERIAL AND METHODS In this retrospective cohort study, 566 OSCC patients undergoing free flap reconstruction over five years were analyzed. Transfusion rates were determined, and predictors were assessed using univariate and multivariate logistic regression models.

RESULTS The overall transfusion rate was 59.7%. Fibula free flaps showed a high rate (82.7%), while radial forearm flaps required transfusion in 37.3% of patients. In reconstruction of mandible a transfusion rate of 83.7% was observed. Univariate analyses identified fibula (OR 4.95), anterolateral thigh (4.83), scapula (4.09), osseous free flaps (OR 4.34) and T4 tumor-stage (OR 6.45) as significant predictors. In multivariate analyses preoperative anemia (OR 3.98), antiplatelet therapy (OR 2.16), previous free flap surgery (OR 10.06), reconstruction of mandible (OR 6.27), floor of mouth (OR 4.02) and maxilla (OR 3.03) area, more than one reconstruction area (OR 5.20), N3 (OR 5.26) and T3 tumor-stage (OR 2.40) showed significant influence on transfusion. Mean perioperative requirements were 1.7 red blood cell (RBC) and 1.3 fresh frozen plasma (FFP) units.

CONCLUSION Free flap surgery for OSCC is associated with substantial transfusion needs. Preoperative anemia emerged as the most relevant modifiable factor. Evidence-based correction of anemia and transfusion-oriented preoperative planning - including provision of at least two RBC - may enhance perioperative PBM.