Abstract
Background Blood transfusions have been associated with surgical complications; however, these
studies are not specific to lower extremity (LE) reconstruction. We evaluated the
effect of perioperative packed red blood cell (PRBC) transfusions on LE free flap
outcomes in trauma patients.
Methods Patients undergoing LE free flap reconstruction following acute injuries from 2016
to 2021 were retrospectively analyzed. The perioperative period for transfusions was
defined as ± 3 days from the procedure. Parameters included demographics, perioperative
characteristics, and outcomes. Major complications were complications requiring reoperation.
Univariate and multivariate analyses were performed to identify associations.
Results Of the 205 patients, 48% received PRBCs perioperatively. There was a trend toward
higher major complications rate in the transfusion group (19 vs. 10%, p = 0.09). Wound size, injury severity score (ISS), and intraoperative estimated blood
loss were greater in the transfusion group (p < 0.01). Preoperative hemoglobin/hematocrit were lower in the transfusion group (p < 0.001). Units of PRBCs transfused were independently associated with major complications
on multivariate analysis (odds ratio [OR] = 1.34, confidence interval [CI]: 1.06–1.70,
p = 0.015) and length of hospital stay (LOS; OR = 1.05, CI: 1.02–1.08, p = 0.002). Infection, wound size, ISS, and preoperative hemoglobin/hematocrit were
independently associated with increased LOS (p < 0.05) but not with major complications.
Conclusion The number of units of PRBCs given perioperatively was the only variable independently
associated with major complications on multivariate analysis and was one of many variables
associated with increased LOS. These findings suggest the usage of restrictive transfusion
protocols in trauma patients requiring LE reconstruction.
Keywords
free tissue transfer - limb salvage - blood transfusion
