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. 2021 Jan 14;6(1):94-102.
doi: 10.1002/lio2.441. eCollection 2021 Feb.

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival

Daniel Jacobs  1 , Samipya Kafle  1 , Joseph Earles  2 , Rahmatullah Rahmati  2 , Saral Mehra  2 , Benjamin L Judson  2
Affiliations

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival

Daniel Jacobs et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: To investigate factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and to analyze its effect on short-term and long-term overall survival (OS).

Methods: The National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with laryngeal cancer, who received TL within 60 days of diagnosis, and who had an inpatient LOS ≥1 night. Multivariable binary logistic regression and survival analyses on propensity score matched cohorts with Kaplan-Meier analysis and extended Cox regression were utilized.

Results: Eight thousand two hundred and ninety-eight patients from the NCDB were included. Median inpatient LOS was 8 days after TL (IQR: 7, 12). Prolonged LOS was defined as above the 75th percentile or 13 days or greater. On multivariable analysis, increasing patient age (OR 1.14 per 10 years, P = .003), female sex (OR 1.35, P < .001), and Charlson-Deyo comorbidity score of ≥2 compared to a score of 0 (OR 1.43, P < .001) were associated with prolonged LOS. Patients treated at high surgical case volume centers had a decreased likelihood for prolonged LOS (OR 0.67, P < .001). Ninety-day mortality increased over time in patients who stayed ≥13 days. Prolonged LOS was independently associated with worse OS on multivariable analysis (HR 1.40, 95% CI: 1.22, 1.61) in a matched cohort.

Conclusions: Prolonged LOS after TL serves as a strong indicator for postoperative long-term mortality and may help identify patients who warrant closer surveillance.

Level of evidence: 3.

Keywords: NCDB; inpatient length of stay; laryngeal neoplasm; survival; total laryngectomy.

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Conflict of interest statement

The authors declare no potential conflict of interests.

Figures

FIGURE 1
FIGURE 1
Distribution of inpatient length of stay (LOS) after total laryngectomy in patients who stayed at least 1 day. A, Data shown through 40 days in accordance with the NCDB Data Use Agreement. Dashed line represents a lognormal distribution. IQR, interquartile range; TL, total laryngectomy
FIGURE 2
FIGURE 2
Association of length of hospital stay with A, 90‐day mortality after surgery and B, overall survival past 90 days. A, Error bars represent 95% confidence intervals. B, Kaplan‐Meier analysis was performed on the matched cohort. Dashed line indicates 50% survival with corresponding solid drop lines corresponding to median survival times. Dotted lines represent 95% confidence intervals. LOS, inpatient length of stay; TL, total laryngectomy
FIGURE 3
FIGURE 3
A, Comparison of overall survival in the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results Program (SEER) databases. B, Comparison of overall and disease‐specific mortalities in patients receiving total laryngectomy in the SEER
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