Sarcopenia is associated with blood transfusions in head and neck cancer free flap surgery.

[OBJECTIVE] To determine if sarcopenia is a predictor of blood transfusion requirements in head and neck cancer free flap reconstruction (HNCFFR).

[METHODS] A single-institution, retrospective review was performed of HNCFFR patients with preoperative abdominal imaging from 2014 to 2019. Demographics, comorbidities (modified Charlson Comorbidity Index [mCCI]), skeletal muscle index (cm/m), oncologic history, intraoperative data, and 30-day postoperative complications (Clavien-Dindo score [CD]) were collected. Binary logistic regression was performed to determine predictors of transfusion.

[RESULTS] Eighty (33.5%), 66 (27.6%), and 110 (46.0%) of n = 239 total patients received an intraoperative, postoperative, or any perioperative blood transfusion, respectively. Sixty-two (25.9%) patients had sarcopenia. Patients receiving intraoperative transfusions had older age ( = .035), more frequent alcoholism ( = .028) and sarcopenia ( < .001), greater mCCI ( < .001), lower preoperative hemoglobin ( < .001), reconstruction with flaps other than forearm ( = .003), and greater operative times ( = .001), intravenous fluids ( < .001), and estimated blood loss (EBL,  < .001). Postoperative transfusions were associated with major complications (CD ≥ 3;  < .001). Multivariate regression determined sarcopenia ( = .023), mCCI ( = .013), preoperative hemoglobin ( = .002), operative time ( = .036), and EBL ( < .001) as independent predictors of intraoperative transfusion requirements. Postoperative transfusions were predicted by preoperative hemoglobin ( = .007), osseous flap ( = .036), and CD ≥ 3 ( < .001). A perioperative transfusion was predicted by sarcopenia ( = .021), preoperative hemoglobin ( < .001), operative time ( = .008), and CD ≥ 3 ( = .018).

[CONCLUSION] Sarcopenia is associated with increased blood transfusions in HNCFFR. Patients should be counseled preoperatively on the associated risks, and the increased blood product requirement should be accounted in resource-limited scenarios.

[LEVEL OF EVIDENCE] 4.