Conclusion
Blood transfusions in ENT have decreased in our centre over the last
five years in a specialty that already uses fewer transfusions in
comparison to other surgical specialties. Epistaxis is amongst the
commonest presentations in ENT requiring transfusing which is likely due
to patient risk factors. HNC post-operative RBC use makes up 58.8% of
the overall post-operative transfusion burden. This is likely owing to
the increased complexity of cases as well as advanced tumour stages,
requirement for a flap and pre-existing anaemia. The majority of the
outliers (in terms of threshold for transfusion according to guidelines)
in our subgroup analysis were related to flap reconstruction surgery
despite growing evidence this may not result in patient benefit. The
future involves a need for more rigorous prehabilitation programmes in
ENT, the efficacy of which have been demonstrated across several
surgical domains including general, cardiothoracic and orthopaedic
surgery.25 In this current climate where optimising
healthcare resources is essential, it is appropriate that thorough
measures of pre-operative optimisation are implemented. This includes
cost-effective supplementation with iron, folate and vitamin B12 to
tackle pre-existing anaemia, which may reduce the need for blood
transfusions. In addition, it may be necessary to revise highly
selective individualised surgeon practices in order to optimise outcomes
for our patients, reduce exposure to potential transfusion related
morbidity and also further decrease the cost incurred to the health
service.