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Title: Management of Peri-operative Haemoglobin Levels in patients undergoing Head and Neck Cancer Free Flap Reconstruction


Authors: Ciara Boyd (1), Mr Andrew Dias (1), Ms Jemima Dorairaj (1), Natasha Christodoulides (1), Professor Conor Barry (1), Professor Patrick Sheahan (1)
Publication: Journal of The Irish Head and Neck Society - 2025
Issue: 3 Volume: 3
Published: January, 2025 View PDF

Background:
In head and neck cancer (HNC) free flap surgery, ample literature demonstrates the association of pre-operative anaemia with higher rates of post-operative complications and lower overall survival. This study aims to retrospectively assess pre-operative haemoglobin levels in our HNC free flap patients and evaluate association with 30-day outcomes.

Methods:
Data was retrospectively collected following chart review of 48 patients who underwent free flap reconstruction to the head and neck between January 2023 and August 2024 in a single unit. Patients under the care of the ENT, plastic surgery and maxillofacial surgery were included.

Results:
Overall, 27% (n=13) of our patient cohort had a pre-operative haemoglobin level <12.5g/dL. Of these patients, 15% (n=2) developed wound healing complications and 7.7% (n=1) returned to theatre within 30 days of surgery. No patients received an intra-operative blood transfusion. Our cohort is too small to definitively comment on a significant correlation between pre-operative Hb levels and 30-day outcomes.

Conclusion:
Our results show a significant proportion of our HNC free flaps are anaemic pre-operatively. UK National Multidisciplinary Guidelines recommend intravenous iron for anaemia (Hb<12.5g/dL) in the urgent HNC patient. Development of a patient pathway is required in our unit, where HNC patients are formally pre-assessed and pre-habilitated.

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