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47. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 21. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

08.09. - 10.09.2016, Kassel

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Predictors of intraoperative blood transfusion in free tissue transfer

Analyse von Prädiktoren für intraoperative Bluttransfusionen bei freien Lappenplastiken

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  • presenting/speaker Jonas Kolbenschlag - Martin-Luther-Krankenhaus Berlin, Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Berlin, Deutschland
  • Johanna Schneider - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Kamran Harati - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Ole Goertz - Martin-Luther-Krankenhaus Berlin, Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Berlin, Deutschland
  • Rainer Kempf - BG Universitätsklinikum Bergmannsheil, Institut für Klinische Chemie, Transfusions- und Laboratoriumsmedizin, Bochum, Deutschland
  • Marcus Lehnhardt - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Nicolai Kapalschinski - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland
  • Tobias Hirsch - BG Universitätsklinikum Bergmannsheil, Klinik für Plastische Chirurgie und Schwerbrandverletzte, Bochum, Deutschland

Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen. Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen. 47. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 21. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC). Kassel, 08.-10.09.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc156

doi: 10.3205/16dgpraec156, urn:nbn:de:0183-16dgpraec1561

Published: September 27, 2016

© 2016 Kolbenschlag et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: Free tissue transfer has become a safe and reliable procedure and is routinely used in a variety of settings. However, it is associated with lengthy operating times and a high potential for blood loss and consecutive red blood cell transfusions (RBCT).

Methods: To assess the risk for RBCTs, we retrospectively identified 398 patients undergoing free tissue transfer between 2005 and 2014. Based on a multivariate model of risk factors and their respective odds ratio, a risk score was developed to predict the likelihood of the need for intraoperative RBCT.

Results: The median age at the time of operation was 51.3±15 years, 278 (70%) patients were male. The average BMI was 25.9±4 and the median ASA score was 2 (Range 1-4). Mean duration of surgery was 319.8±108 minutes and mean duration of hospital stay was 45.8±40 days. A total of 231 patients (58%) required perioperative RBCTs, all of which were allogenic. RBCTs were performed 0-48 hours preoperatively in 36 patients (11.3%), intraoperatively in 166 patients (41.7%) and 0-48 hours postoperatively in 125 patients (31.4%). The mean amount of overall RBCTs given was 2.5±3.7 units and 1.1±1.9 units for intraoperative transfusions.

Conclusion: The following risk factors were statistically significant in the multivariate regression analysis and included in the risk score: Age >60 years, a preoperative hemoglobin concentration of <11g/dl, a preoperative platelet count of >400/nl, history of renal (RI) and cardial insufficiency (CI), defect localization on the proximal extremities, head and neck or trunk and the use of myocutaneous flaps. This score assessed the risk for RBCTs with a sensitivity of 77%, a specificity of 81% and an AUC of the ROC curve of 0.86.