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

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.

Textbook outcome was associated with better survival in oral cancer surgery in southern Taiwan

“…Theoretically, adequate neck dissection defined by lymph node yield, and negative margins were associated with better outcomes (Anderson et al, 2015; Divi et al, 2016). Thirty‐day readmission after major head and neck cancer, and prolonged length of stay, another proxy of imperfect surgery and comorbidities, were associated with worse long‐term outcomes (Jacobs et al, 2021; Yin et al, 2020). Thereafter, overall TO could be regarded as a summation of preoperative evaluation, surgery, and postoperative care.…”