Patients Undergoing Total Laryngectomy

Abstract

IMPORTANCE Patients undergoing total laryngectomy are at high risk for hospital readmission. Hospital readmissions are increasingly scrutinized because they are used as a metric of quality care and are subject to financial penalties. OBJECTIVE To determine the rate of, reasons for, and risk factors that predict 30-day unplanned readmission for patients undergoing total laryngectomy. DESIGN, SETTING, AND PATIENTS Retrospective cohort study at a single academic tertiary referral medical center. The study population comprised 155 patients who underwent total laryngectomy with or without flap closure between January 2007 and December 2012 as either a primary treatment or salvage treatment for prior nonsurgical management. INTERVENTIONS Total laryngectomy. MAIN OUTCOMES AND MEASURES Rate of 30-day unplanned readmission, readmission diagnoses, and risk factors for unplanned readmission. Univariable and multivariable logistic regression were performed to identify risk factors for unplanned readmission within 30 days of discharge. RESULTS The 30-day unplanned readmission rate for patients following discharge after total laryngectomy was 26.5% (41 of 155). The most common readmission diagnoses were pharyngocutaneous fistula (27% of readmissions; n = 11) and stomal cellulitis (16% of readmissions; n = 7). The median time to unplanned readmission was 7 days. Thirty-four percent of readmissions (14 of 41) occurred within 3 days of discharge. Significant predictors of 30-day unplanned readmission on multivariable analysis were postoperative complication after discharge (odds ratio [OR], 11.50; 95% CI, 4.10–32.28), visit to the emergency department within 30 days after discharge (OR, 5.25; 95% CI, 1.84–14.99), salvage total laryngectomy (OR, 3.52; 95% CI, 1.56–13.12), and chyle fistula during the index hospitalization (OR, 5.25; 95% CI, 0.86–29.92). The discriminative ability of the model to predict unplanned readmission, as measured by the C statistic, was 0.88. CONCLUSIONS AND RELEVANCE Patients undergoing total laryngectomy are an at-risk patient population with a high rate of unplanned readmission within 30 days of discharge. By identifying the risk factors that predict 30-day unplanned readmission, these data can be used to design and implement quality-improvement interventions to decrease readmissions.

Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy

“…erature, most PCFs after laryngectomy usually occur within 30 days. 8,26 Because the NSQIP database is a general surgical database, it does not include procedure-specific variables for total laryngectomy; so, the variable "wound disruption" was used as a proxy for the development of a PCF. The NSQIP has 2 values for this variable: wound disruption or no complication.…”

Hypothyroidism and Wound Healing After Salvage Laryngectomy

“…9–14 Fistula formation increases short and long term morbidity, prolongs hospitalization, and is the most common cause of wound related death in the post-surgical head and neck cancer patient. 12,14–16 In response, surgeons have developed a variety of reconstructive techniques to reduce the risk of fistula, with significant institutional and surgeon variation in reconstructive patterns employed during salvage surgery. 17–31…”

Effectiveness of fibreoptic endoscopic evaluation of swallowing and dietary intervention during home‐visit dental care in older individuals

“…Generally, FEES has been shown to be extremely safe with all reported complications being minor and spontaneously resolved. 35 In addition, past studies indicated that the information derived from FEES facilitates the discussion between various practitioners, it does not require radiation exposure, and moreover, very severe patients can benefit from FEES. 18,20,36 These studies suggested that the FEES could be one of the most beneficial tools for accurate diagnosis of patients with dysphagia at homes or facilities.…”

“…There have been continuing discussions regarding the safety of FEES. Generally, FEES has been shown to be extremely safe with all reported complications being minor and spontaneously resolved 35 . In addition, past studies indicated that the information derived from FEES facilitates the discussion between various practitioners, it does not require radiation exposure, and moreover, very severe patients can benefit from FEES 18,20,36 .…”