Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 May 15;123(10):1760-1767.
doi: 10.1002/cncr.30483. Epub 2016 Dec 27.

Complications, hospital length of stay, and readmission after total laryngectomy

Ryan P Goepfert  1 , Katherine A Hutcheson  1 , Jan S Lewin  1 , Neha G Desai  1 , Mark E Zafereo  1 , Amy C Hessel  1 , Carol M Lewis  1 , Randal S Weber  1 , Neil D Gross  1
Affiliations

Complications, hospital length of stay, and readmission after total laryngectomy

Ryan P Goepfert et al. Cancer. .

Abstract

Background: The purpose of this study was to describe the 30-day incidence of complications after total laryngectomy (TL) in a high-volume institution and their impact on the hospital length of stay (LOS) and readmission rates.

Methods: A retrospective cohort study of all patients who underwent TL at The University of Texas MD Anderson Cancer Center from January 1, 2010 through June 30, 2013 was conducted. The patient demographics, treatment history, LOS, and 30-day post-TL complications and readmissions were extracted from the medical record. Univariate associations were analyzed, and stepwise backward selection methods were used to fit multivariate models.

Results: Two hundred forty-five patients were included. Complications occurred in 83 patients (33.9%) and included 3 deaths (1.2%). Wound complications occurred in 53 patients (21.6%), and 34 were pharyngocutaneous fistulas (PCFs; 13.9% overall). Thirty-four patients (13.9%) were readmitted within 30 days. A multivariate analysis revealed the following: wound complications were associated with former (odds ratio [OR], 5.1; P = .03) and current smokers (OR, 5.8; P = .02), PCFs were associated with prior wide-field radiation (OR, 3.1; P = .01) but not prior narrow-field (larynx-only) radiation (OR, 1.4; P = .61), LOS was associated with the type of flap (P = .002) and postoperative hematomas (P = .05), and readmissions were associated with preoperative hypoalbuminemia (P = .003) and postoperative wound complications (P < .001).

Conclusions: Complications occurred in approximately one-third of TL patients and particularly in patients with poor wound-healing risk factors such as prior smoking and radiation. As expected, LOS was longer among reconstructed patients. Readmission was associated with hypoalbuminemia and postoperative wound complications. These data can inform quality improvement efforts and the counseling of high-risk patients undergoing TL. Cancer 2017;123:1760-1767. © 2016 American Cancer Society.

Keywords: complications; laryngectomy; radiation; readmission; smoking.

PubMed Disclaimer

Conflict of interest statement

Disclosures: The authors have no disclosures or conflicts of interest to report.

Figures

Figure 1
Figure 1
Multivariate analysis results for wound complications, pharyngocutaneous fistula, and hospital readmission.
Figure 2
Figure 2
Length of stay stratified by type of flap reconstruction.
See this image and copyright information in PMC

References

    1. Group* TDoVALCS. Induction Chemotherapy plus Radiation Compared with Surgery plus Radiation in Patients with Advanced Laryngeal Cancer. New England Journal of Medicine. 1991;324:1685–1690. - PubMed
    1. Forastiere AA, Goepfert H, Maor M, et al. Concurrent Chemotherapy and Radiotherapy for Organ Preservation in Advanced Laryngeal Cancer. New England Journal of Medicine. 2003;349:2091–2098. - PubMed
    1. Gourin CG, Johnson JT. A contemporary review of indications for primary surgical care of patients with squamous cell carcinoma of the head and neck. Laryngoscope. 2009;119:2124–2134. - PubMed
    1. Eisbruch A, Schwartz M, Rasch C, et al. Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: Which anatomic structures are affected and can they be spared by IMRT? International Journal of Radiation Oncology Biology Physics. 2004;60:1425–1439. - PubMed
    1. Fung K, Lyden TH, Lee J, et al. Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer. International Journal of Radiation Oncology Biology Physics. 2005;63:1395–1399. - PubMed

MeSH terms