Postoperative Hemoglobin and Transfusion Rates Do Not Influence Revision of Head and Neck Free Flap in a Cohort of 259 Patients.

INTRODUCTION

Recent literature advocates restrictive transfusion thresholds (Hb < 7 g/dL). The aim of this study was to evaluate if postoperative hemoglobin levels and transfusions influence Free Flap Revision (FFR).

METHODS

This single center retrospective study included all patients who underwent head and neck surgery with free flap reconstruction (other than radial forearm free flap) from 2020 to 2024. A restrictive transfusion strategy was applied.

RESULTS

Among the 259 patients included, 21.6% underwent FFR for flap compromise or dehiscence. Active smoking (OR 2.20; p = 0.019) and hypoalbuminemia were associated with FFR (OR 1.06; p = 0.075) in multivariable analysis. Daily and minimum postoperative (but prerevision) hemoglobin values and the frequency of blood transfusions were not associated with FFR.

CONCLUSION

In this study, when applying a restrictive transfusion threshold (< 7 g/dL), postoperative hemoglobin levels and transfusion rates within the observed range were not associated with FFR. This is consistent with the safety of restrictive transfusion practices.