Avoiding transfusion in head and neck surgery: Feasibility study of erythropoietin

Objective: To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery, Study Design: Retr ospective chart review. Methods: Ninety-nine patients undergoing surgical r esection of head and neck tumors at our institution were assessed for demog raphic data, nutritional parameters, tumor/surgical information, hematologi cal/transfusion data, and contraindications to erythropoietin, Each transfu sion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also perf ormed. Results: Most transfused patients (63%) received too many units. A s ubgroup at high risk of transfusion was identified who would benefit most f rom perioperative erythropoietin, Assuming that perioperative erythropoieti n therapy is equivalent to the transfusion of 4 units, we estimate that the majority (74%) of transfused patients would not have required a transfusio n if more stringent transfusion criteria were followed and those at high ri sk were given perioperative erythropoietin, Although the cost for transfusi ng 4 units is equivalent to that of a perioperative course of erythropoieti n, the overall direct cost of erythropoietin treatment would actually have been more expensive, Conclusions: Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prosp ective randomized controlled study in such a subgroup is needed to better d efine those most likely to benefit from it and to assess actual cost/benefi t ratios.