Retrospective study demonstrates that postoperative hemoglobin levels and transfusion rates do not increase free flap revision in head and neck surgery, supporting restrictive transfusion safety.
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.
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Gilbert et al. (2026) studied this question.
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