Perioperative Transfusion Following Total Laryngectomy: A Nationwide Study

Area of Science:

• Oncology
• Surgery
• Hematology

Background:

• Total laryngectomy (TL) is a complex surgical procedure often performed on medically fragile patients.
• The specific impact of perioperative blood transfusions on outcomes following TL is not well-established.
• Understanding these impacts is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To characterize patients undergoing total laryngectomy using a national database.
• To investigate the association between perioperative blood transfusion and postoperative outcomes in TL patients.
• To explore a potential dose-dependent relationship between the volume of transfused blood and adverse events.

Main Methods:

• Utilized the National Surgical Quality Program (NSQIP) database from 2014-2022 for patients undergoing TL.
• Included CPT codes 31360 and 31365 for TL with or without neck dissection.
• Employed statistical analyses including hypothesis testing, multivariate logistic regression, and ROC analysis; transfusion unit data available for 2020-2023.

Main Results:

• Out of 2311 TL patients, 17.9% received transfusions.
• Transfused patients experienced longer hospital stays (12 vs. 9 days), increased complications (stroke, DVT), higher reoperation rates (23.2% vs. 13.9%), and greater mortality (2.7% vs. 0.8%).
• Receiver operating characteristic (ROC) analysis indicated that transfusion of more than 2.5 units was associated with adverse outcomes.

Conclusions:

• Total laryngectomy is a significant surgical undertaking with potential for complex hospital courses.
• Perioperative blood transfusion in TL patients is associated with increased hospital stay, reoperation, and mortality.
• Findings support cautious use of blood products in TL patients, highlighting potential dose-dependent risks.