The Transfusion Dilemma in Free Tissue Transfer

Abstract

Objective: Despite the NIH recommendation for transfusions based on the individual patient, many microvascular surgeons continue to use a trigger point to guide transfusion criteria in patients undergoing free tissue transfer. Our objective is to learn the effects of blood transfusion on complications in free tissue transfer patients. Method: A retrospective study of patients undergoing free tissue transfer with and without blood transfusions from June 2005 through May 2011 at a single tertiary care center. Outcome measurements include flap failure, hematoma, fistula rate, respiratory failure and cardiovascular events. Results: A total of 225 patients underwent free tissue transfer during the study period. One hundred twenty-one patients received either intraoperative or postoperative blood products. When compared to a group of 100 patients similar in age, BMI and pre/post-operative hematocrit levels, there was a statically significant difference in total hospital length of stay (7.8 vs 9.5 days, P = .01) and total rate of complications (9 vs 33.8%, P = .0002). Specific post-operative complication rates were as follows; flap failure (2% vs 5.7% failure rate), respiratory failure (0 vs 12.6% patients required prolonged ventilatory support), and hematoma rates of 2% and 12%, respectively. Conclusion: For patients undergoing free tissue transfer, transfusion of blood products is associated with a statistically significant increase in postoperative morbidity. We propose basing transfusion criteria on an individual basis rather than by means of a trigger point.