gms | German Medical Science

Objectives/Interrogation: To establish the relationship between the use of perioperative transfusions and the development of vascular pedicle thrombosis in free flap procedures

Methods: Retrospective cohort comparing the incidence of vascular pedicle thrombosis over the first 7 postoperative days (168 hours) considering the exposed group as patients who received blood transfusions in the 24 hours prior, during or 24 hours after surgery; versus the Unexposed group, patients who did not receive transfusions during that period of time. Kaplan Meier survival curves were developed and compared; the incidence rates were estimated and a proportional risk regression was done to adjust for confounding variables.

Results and Conclusions: 157 free flaps in 135 patients were included. The incidence of vascular pedicle thrombosis was higher among patients transfused (30.2%) versus the non-transfused (15.8%). When adjusting for clinical confounding variables, the hazard ratio was calculated at 2.68 (95% CI: 1.09 to 6.59).

Perioperative red blood cells transfusion is associated with a higher risk of vascular pedicle thrombosis. Because no association was established between pre-surgical anemia and free flap survival, the decision to transfuse shall be based on the individual clinical condition of each particular patient, rather than on a range of hemoglobin or hematocrit.