Peri-operative factors predisposing to pharyngocutaneous fistula after total laryngectomy: analysis of a large multi-institutional patient cohort

BackgroundPharyngocutaneous fistula (PCF) is a problematic complication following total laryngectomy. Disagreement remains regarding predisposing factors. This study examines perioperative factors predicting PCF following total laryngectomy using a large multicenter data registry.MethodsRetrospective cohort analysis was performed using patients undergoing total laryngectomy in the ACS-NSQIP database for 2006–2014. Sub-analysis was performed based on reconstruction type. Outcome of interest was PCF development within 30 days.ResultsMultivariate analysis of 971 patients was performed. Three variables showed statistical significance in predicting PCF: wound classification of 3 and 4 vs. 1–2 (OR 6.42 P < 0.0004 and OR 8.87, P < 0.0042), pre-operative transfusion of > 4 units of packed red blood cells (OR 6.28, P = 0.043), and free flap versus no flap reconstruction (OR 2.81, P = 0.008).ConclusionsThis study identifies important risk factors for development of PCF following total laryngectomy in a large, multi-institutional cohort of patients, thereby identifying a subset of patients at increased risk.

• Publication year

  2017

• Venue

  Journal of Otolaryngology - Head & Neck Surgery

• Publication date

  2017-08-23

• Fields of study

  Medicine

• Identifiers
  DOI 10.1186/s40463-017-0233-zPMID 28830509PMCID 5568352
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• American College of Surgeons

  2020cited by this paper
• The Effect of Operative Time on Outcomes in Minimally Invasive and Abdominal Myomectomy: An Analysis of the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP)

  2016cited by this paper
• JACS CME and the ACS NSQIP Surgical Risk Calculator.

  2016cited by this paper
• Pharyngocutaneous fistula after total laryngectomy: a single-institution experience, 2001-2012.

  2015cited by this paper
• Pharyngocutaneous fistula after total laryngectomy: Systematic review of risk factors

  2015influential reference
• Pharyngocutaneous fistula after total laryngectomy: A systematic review and meta-analysis of risk factors.

  2015influential reference
• Preventing pharyngo‐cutaneous fistula in total laryngectomy: A systematic review and meta‐analysis

  2014cited by this paper
• Analysis of Predisposing Factor for Pharyngocutaneous Fistula in Laryngeal Carcinoma Patients

  2014cited by this paper
• Impact of pharyngeal closure technique on fistula after salvage laryngectomy.

  2013cited by this paper
• Pharyngocutaneous fistula following total laryngectomy

  2012cited by this paper
• The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx

  2009cited by this paper
• Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy

  2008cited by this paper
• Pharyngocutaneous fistula after total laryngectomy: emphasis on lymph node metastases as a new predisposing factor.

  2008cited by this paper
• Pharyngocutaneous fistula following total laryngectomy.

  2007cited by this paper
• Pharyngocutaneous fistula following total laryngectomy: a single institution’s 10-year experience

  2006cited by this paper
• Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula.

  2006cited by this paper
• Schwartz's Principles of Surgery

  2004cited by this paper
• Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?

  2004cited by this paper
• Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: A national survey from DAHANCA

  2003cited by this paper
• Pharyngocutaneous Fistula as a Complication of Total Laryngectomy: Review of the Literature and Analysis of Case Records

  2000cited by this paper
• Pharyngocutaneous fistula following laryngectomy

  1998cited by this paper
• The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program.

  1998cited by this paper
• Pharyngocutaneous fistula following laryngectomy.

  1995cited by this paper
• Complications in head and neck surgery.

  1983cited by this paper
• Complications of head and neck surgery.

  1971influential reference
• WOUND healing.

  1959cited by this paper

• Preventing and managing pharyngocutaneous fistula after total laryngectomy - A narrative review

  2025cites this paper
• A modified vertical pressure bandage to prevent pharyngocutaneous fistula after total laryngectomy

  2025cites this paper
• Risk factors for postoperative pharyngocutaneous fistula after total laryngectomy

  2025cites this paper
• Pharyngeal Stenosis and Swallowing Dysfunction Following Laryngectomy: A Scoping Review

  2025cites this paper
• Revisiting the closed stapler laryngectomy: Technique and review of recent evidence.

  2024cites this paper
• Pharyngocutaneous Fistula Following Total Laryngectomy: a High-Volume Tertiary Centre Series

  2023cites this paper
• Clinical factors associated with severe surgical complications in patients with hypopharyngeal cancer: a single-center case-cohort study

  2023cites this paper
• A NSQIP study comparing surgical outcomes between primary and non-primary TEPs after total laryngectomy.

  2023cites this paper
• Evaluation of the Incidence of Pharyngocutaneous Fistula after Total Laryngectomy

  2023influential citation
• Risk Factors for Pharyngocutaneous Fistula Following Total Laryngectomy

  2022influential citation
• Delayed Pharyngocutaneous Fistula After Total Laryngectomy Caused by an Anterior Cervical Spine plate

  2022cites this paper
• Effects of Prior Tracheostomy on Total Laryngectomy Outcomes.

  2022cites this paper
• A Case of Multiple Pharyngocutaneous Fistulae Following Post-Operative Concurrent Chemoradiotherapy for Oropharyngeal Cancer

  2021cites this paper
• “Fistula Zero” Project After Total Laryngectomy: The Candiolo Cancer Institute Experience

  2021cites this paper
• Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy.

  2021cites this paper
• Nutritional predictors of pharyngocutaneous fistula after total laryngectomy: A multivariate analytic study in a single institution.

  2021cites this paper
• Low skeletal muscle mass assessed directly from the 3rd cervical vertebra can predict pharyngocutaneous fistula risk after total laryngectomy in the male population

  2021cites this paper
• Incidence and risk factors of pharyngocutaneus fistula formation after total laryngectomy. Review

  2020cites this paper
• Recurrent Aphthous Stomatitis in Children: A Practical Guideline for Paediatric Practitioners.

  2020cites this paper
• Development of Pharyngocutaneous Fistula after Total Laryngectomy: The Predictive Value of C-reactive Protein/Albumin Ratio.

  2020cites this paper
• Is It Important Which Suturing Technique Used for Pharyngeal Mucosal Closure in Total Laryngectomy? Modified Continuous Connell Suture May Decrease Pharyngocutaneous Fistula

  2020cites this paper
• Early Adverse Events Following Transcervical Hypopharyngeal Diverticulum Surgery

  2020cites this paper
• Pharyngocutaneous Fistula Following Primary and Salvage Laryngectomy: Aetiology and Predictive Factors

  2020cites this paper
• Pharyngocutaneous Fistula which Occurred During Postoperative Radiotherapy in Larynx Cancer Patient with Dementia

  2019cites this paper
• Association of Preoperative Anemia With 30-Day Morbidity and Mortality Among Patients With Thyroid Cancer Who Undergo Thyroidectomy

  2019cites this paper
• Free Flap Versus Pedicled Flap Reconstruction of Laryngopharyngeal Defects: A 10‐Year National Surgical Quality Improvement Program Analysis

  2018cites this paper
• Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal

  2018cites this paper
• Use of the sternocleidomastoid muscle collar flap in the surgical treatment of the pharyngostoma. Case report and literature review

  2017cites this paper