Perioperative Transfusion Following Total Laryngectomy: A Nationwide Study

Total laryngectomy (TL) represents a major operation often performed on medically complex patients. The impact of blood transfusion in TL patients is not well defined. Here, we utilize a national database to characterize these patients and further investigate a potential dose-dependent relationship between transfusion and postoperative outcomes.

The National Surgical Quality Program (NSQIP) was queried for patients who underwent TL with/without neck dissection (CPT 31360, 31365) between 2014 and 2022. Total units of transfused blood were only available for patients between 2020 and 2023. Statistical analysis involved hypothesis testing, multivariate logistic regression, and receiver operating characteristic (ROC) analysis.

Among 2311 patients, 413 (17.9%) received transfusions. Non-White race, ASA Class ≥ 3, hypertension, cancer with distant metastases, bleeding disorders, and elevated BUN, WBC, and INR were associated with transfusion (p < 0.05). Multivariate analysis identified hypertension (OR 1.81), bleeding disorders (OR 2.64), ASA ≥ 3 (OR 2.40), concurrent free flap (OR 3.75) and lower hematocrit (OR 0.85) as predictors. Transfused patients had longer hospital stays (12 vs. 9 days), increased complications (e.g., stroke, DVT), higher reoperation (23.2% vs. 13.9%) and mortality (2.7% vs. 0.8%) (p < 0.05). ROC analysis suggested transfusion > 2.5 units was associated with adverse outcomes.

TL remains a major surgical endeavor that can be associated with lengthy and complicated hospital courses. We show that perioperative transfusion may be associated with increased hospital stay, reoperation, and mortality in TL patients, with a potential dose-dependent effect. Our study reinforces the risks associated with blood transfusion and further supports the thoughtful utilization of blood products in TL patients.