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Predictive factors for pharyngocutaneous fistulization after total laryngectomy: a Dutch Head and Neck Society audit.
- Source :
-
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery [Eur Arch Otorhinolaryngol] 2018 Mar; Vol. 275 (3), pp. 783-794. Date of Electronic Publication: 2018 Jan 16. - Publication Year :
- 2018
-
Abstract
- Background: Incidences of pharyngocutaneous fistulization (PCF) after total laryngectomy (TL) reported in the literature vary widely, ranging from 2.6 to 65.5%. Comparison between different centers might identify risk factors, but also might enable improvements in quality of care. To enable this on a national level, an audit in the 8 principle Dutch Head and Neck Centers (DHNC) was initiated.<br />Methods: A retrospective chart review of all 324 patients undergoing laryngectomy in a 2-year (2012 and 2013) period was performed. Overall PCF%, PCF% per center and factors predictive for PCF were identified. Furthermore, a prognostic model predicting the PCF% per center was developed. To provide additional data, a survey among the head and neck surgeons of the participating centers was carried out.<br />Results: Overall PCF% was 25.9. The multivariable prediction model revealed that previous treatment with (chemo)radiotherapy in combination with a long interval between primary treatment and TL, previous tracheotomy, near total pharyngectomy, neck dissection, and BMI < 18 were the best predictors for PCF. Early oral intake did not influence PCF rate. PCF% varied quite widely between centers, but for a large extend this could be explained with the prediction model. PCF performance rate (difference between the PCF% and the predicted PCF%) per DHNC, though, shows that not all differences are explained by factors established in the prediction model. However, these factors explain enough of the differences that, compensating for these factors, hospital is no longer independently predictive for PCF.<br />Conclusions: This nationwide audit has provided valid comparative PCF data confirming the known risk factors from the literature which are important for counseling on PCF risks. Data show that variations in PCF% in the DHNCs (in part) are explainable by the variations in these predictive factors. Since elective neck dissection is a major risk factor for PCF, it only should be performed on well funded indication.
- Subjects :
- Adult
Aged
Cutaneous Fistula epidemiology
Female
Humans
Incidence
Male
Medical Audit
Middle Aged
Neck Dissection adverse effects
Outcome Assessment, Health Care
Pharyngeal Diseases epidemiology
Pharyngectomy adverse effects
Postoperative Complications epidemiology
Respiratory Tract Fistula epidemiology
Retrospective Studies
Risk Factors
Cutaneous Fistula etiology
Laryngectomy
Pharyngeal Diseases etiology
Postoperative Complications etiology
Respiratory Tract Fistula etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1434-4726
- Volume :
- 275
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 29340771
- Full Text :
- https://doi.org/10.1007/s00405-017-4861-8