Predictors of length of stay, reoperation, and readmission following total laryngectomy

Abstract

4. Laryngoscope, 127:1339-1344, 2017.

Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10‐Year National Surgical Quality Improvement Program Analysis

“…There are several known risk factors for postoperative complications after a TL or TLP . In addition to patient comorbidities, several other factors have been associated with complications after TL, including closure technique, surgeon experience, use of salivary bypass tubes, administration of perioperative antibiotics, and perioperative use of proton pump inhibitors . Significant predictors of complications after reconstruction in this study, for TL or TLP with reconstruction were a history of stroke and low preoperative hematocrit, whereas older age and recent history of congestive heart failure were predictors of increased hospital stay.…”

“…Although the NSQIP data do not report fistula formation as a distinct complication, the complication wound dehiscence was used as a surrogate for fistula, as it has similarly been used in a recent study . In addition, wound infection was considered to occasionally be secondary to fistula formation and has been used as a surrogate for fistula in other studies . By comparing both the rates of wound dehiscence and wound infection, we aimed to capture the cases with fistula formation with a conservative estimate.…”

Risk factors for thirty‐day readmission following flap reconstruction of oncologic defects of the head and neck

“…Patients undergoing laryngectomy or laryngopharyngectomy are at an elevated risk of surgical complications, and several authors have examined readmission rates in this patient population. Helman et al examined 871 patients who underwent total laryngectomy for laryngeal cancer using the NSQIP database and reported an 11.9% readmission rate within 30 days of surgery . Patients undergoing free flap reconstruction were excluded.…”

Use of surgical sealant in the prevention of pharyngocutaneous fistula after total laryngectomy

“…1,2 The incidence of pharyngocutaneous fistula in the published literature has varied widely and has ranged from <10% to >50%. 5,6 Spontaneous closure of pharyngocutaneous fistula typically occurs; however, surgical repair can be required and may involve use of a tissue flap. 4 Pharyngocutaneous fistula is associated with a significantly increased duration of hospital stay and readmission.…”