Hypothyroidism and Wound Healing After Salvage Laryngectomy

Rosko, Andrew J.; Birkeland, Andrew C.; Bellile, Emily L.; Kovatch, Kevin J.; Miller, Ashley L.; Jaffe, C.C.; Shuman, Andrew G.; Chinn, Steven B.; Stucken, Chaz L.; Malloy, Kelly M.; Moyer, Jeffrey S.; Casper, Keith; Prince, Mark E.; Bradford, Carol R.; Wolf, Gregory T.; Chepeha, Douglas B.; Spector, Matthew E.

doi:10.1245/s10434-017-6278-4

Cited by 30 publications

(30 citation statements)

References 52 publications

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“…The parameters included both researchsupported interventions known to improve outcomes in head and neck free-tissue reconstruction as well as several experimental parameters gathered prospectively by the authors. [6][7][8][9][10][11][12][13][14] Preoperative hypothyroidism was specifically included in the overall checklist for investigation of our salvage laryngectomy population outcomes. The preoperative checklist (Fig.…”

Section: Methodsmentioning

confidence: 99%

Improving Head and Neck Microvascular Reconstructive Care with a Novel Perioperative Checklist

et al. 2021

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Objective/Hypothesis: To appraise the utility of a novel EMR-based checklist for complex head and neck microvascular free-tissue reconstruction.Study Design: A prospectively collected retrospective matched cohort study from a single tertiary care academic institution.Methods: A retrospective matched cohort study from an academic tertiary care center with 76 total patients analyzed for disease-specific and quality outcomes before and after implementation of an EMR-based checklist tailored to complex head and neck care. The intervention group consisted of 38 consecutive patients undergoing microvascular free tissue reconstruction after implementation of the EMR-based checklist strategy. A historic cohort of 38 patients was derived by matching patients meticulously for disease-specific and surgical characteristics. Primary outcomes included post-operative medical and surgical complications, intensive care requirements, 30-day reoperation rates, hospital length of stay, and completion of preoperative metastatic evaluations. Secondary outcomes included patterns of antibiotic administration, ultimate discharge dispositions, flap survival, and recognition of preoperative hypothyroidism in previously radiated patients.Results: Implementation of the perioperative checklist yielded an overall reduction in major medical complications (10.5% vs. 29.0%, P < .05*), post-operative antibiotic administration (17.4% vs. 44.7%, P < .05*), hospital length of stay (median (IQR) days 6 (1) versus 7 (3.25), P < .05*), and improved metastatic evaluation completion (92.1% vs. 63.2%, P < .05*). There was an improved discharge disposition (92.1% vs. 73.7%, P < .05*). No difference was observed in major wound complications (50.0% vs. 57.9%, P = .49), 30-day re-operation rates (31.5% vs. 34.2%, P = .81), 30-day readmission rates (21.1% vs. 21.1%, P > .99), escalations to intensive-care (13.2% vs. 21.1%, P = .36), or flap survival (97.4% vs. 89.5%, P = .17).Conclusions: Use of our EMR-based perioperative checklist reduced major medical complications, post-operative antibiotic administration, hospital length of stay, and improved discharge outcomes for patients undergoing microvascular free-tissue reconstruction.

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Section: Methodsmentioning

confidence: 99%

Improving Head and Neck Microvascular Reconstructive Care with a Novel Perioperative Checklist

et al. 2021

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“…Another possible factor increased the rate of wound infection and PCF formation may be low thyroid function status perioperatively, especially in patients had prior RT history. In previous study, Rosko et al described postoperative hypothyroidism independently predicts postoperative wound-healing complications including PCF formation in patients who underwent salvage total laryngectomy after RT/CRT [13]. In our cohort, only 41 patients (41/213 = 19.2%) had checked thyroid function status in postoperative period.…”

Section: Factormentioning

confidence: 64%

Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis

et al. 2020

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Objective To determine the predictive factors of postoperative hospital stay and total hospital medical cost among patients who underwent total laryngectomy. Methods A total of 213 patients who underwent total laryngectomy in a tertiary referral center for tumor ablation were enrolled retrospectively between January 2009 and May 2018. Statistical analyses including Pearson's chi-squared test were used to determine whether there was a significant difference between each selected clinical factors and outcomes. The outcomes of interest including postoperative length of hospital stay and inpatient total medical cost. Logistic regression analyses were performed to reveal the relationship between clinical factors and postoperative length of hospital stay or total inpatient medical cost. Results Preoperative radiotherapy (p = 0.007), method of wound closure (p < 0.001), postoperative serum albumin level (p = 0.025), and postoperative serum hemoglobin level (p = 0.04) were significantly associated with postoperative hospital stay in univariate analysis. Postoperative hypoalbuminemia (odds ratio [OR]: 2.477; 95% confidence interval [CI]: 1.189-5.163; p = 0.015) and previous radiotherapy history (OR 2.194; 95% CI: 1.228-3.917; p = 0.008) are independent predictors of a longer postoperative hospital stay in multiple regression analysis. With respect to total inpatient medical cost, method of wound closure (p < 0.001), preoperative serum albumin level (p = 0.04), postoperative serum albumin level (p < 0.001), and history of liver cirrhosis (p = 0.037) were significantly associated with total inpatient medical

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“…The results of the current study are in parallel with earlier studies showing the adverse effects of hypothyroidism on wound healing. 33 Methods for treatment of such wounds include hormone therapy, laser therapy, and pomades. Studies have shown that pomades that made from thyroxin hormone can accelerate the closure of wounds.…”

Section: Discussionmentioning

confidence: 99%

Combined Effect of Low-Level Laser Treatment and Levothyroxine on Wound Healing in Rats With Hypothyroidism

et al. 2018

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Please cite this article as follows: Firouzi A, Norozian M, Amini A, Abdollahifar MA, Abbaszadeh HA, Fadaei Fathabadi F. Combined effect of low-level laser treatment and levothyroxine on wound healing in rats with hypothyroidism. AbstractIntroduction: Hypothyroidism delays wound healing by reducing the synthesis of keratinocytes, fibroblast cells, and collagen. Methods for enhancement of wound healing include laser therapy and hormone therapy. The current study evaluated the combined effect of laser and levothyroxine therapy to cure wounds in male rats with hypothyroidism. Methods: Sixty male Wistar rats were randomly divided into 5 groups: (1) healthy controls;(2) controls with hypothyroidism; (3) hypothyroidism + laser treatment; (4) hypothyroidism + levothyroxine treatment; (5) hypothyroidism + laser + levothyroxine treatment. Hypothyroidism was induced by dissolving 4 mg of methimazole in 100 mL of drinking water daily for 28 days. After hypothyroidism had been confirmed, a longitudinal incisional wound was created on the dorsal rib cages of the rats. The wounds that received laser treatment were divided into 12 sections and treated at 810 nm wavelength and 0.2 J/cm 2 of energy density for 200 seconds. Levothyroxine was administrated in doses of 20 µg/kg/d i.p. All groups were divided into 3 subgroups for testing on days 4, 7 and 14. Samples were collected in all the subgroups. Results: The results showed that hypothyroidism reduced fibrous tissue volume, fibroblasts, and basal cell numbers. The combined effect of laser and levothyroxine improved all parameters. Conclusion: Combined laser and levothyroxine treatment showed the best effect on wound healing and accelerated the closure of the wounds.

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Hypothyroidism and Wound Healing After Salvage Laryngectomy

Abstract: Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.

Cited by 30 publications

References 52 publications

Improving Head and Neck Microvascular Reconstructive Care with a Novel Perioperative Checklist

Improving Head and Neck Microvascular Reconstructive Care with a Novel Perioperative Checklist

Predictors of hospital expenses and hospital stay among patients undergoing total laryngectomy: Cost effectiveness analysis

Combined Effect of Low-Level Laser Treatment and Levothyroxine on Wound Healing in Rats With Hypothyroidism

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