Reduction of pharyngocutaneous fistulae in laryngectomy patients by a comprehensive performance improvement intervention

Ryan Li, Xian Chong Zhou, Carole Fakhry, Juan Negrin, Gregory Lee, Patrick Ha, Ray Blanco, John Saunders, Joseph A. Califano

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Pharyngocutaneous fistula is a common complication in laryngectomy patients, particularly in previously irradiated cases. We initiated a comprehensive performance improvement intervention in all head and neck surgery patients intended to reduce postoperative infection and fistulae rates. We report our review of outcomes within laryngectomy patients. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects Nineteen laryngectomy patients at risk of postoperative fistula formation. Methods We reviewed the medical records of all patients who had undergone laryngectomy procedures between January 2013 and April 2014. Clinicodemographic data were obtained, including history of diabetes, prior radiation therapy, type of reconstruction performed for closure of the pharyngeal defect, and the presence or absence of postoperative fistula. Results The study population comprised 19 laryngectomy patients. Prior to implementation of our performance improvement intervention, 8 of 11 (73%) patients undergoing laryngectomy developed postoperative fistulae. After intervention, 0 of 8 patients developed fistulae (P =.002). Prior radiation, diabetes mellitus, and overall stage were not associated with a reduction in fistula rate (P >.05). Conclusion Comprehensive uniform application of a standard antibiotic prophylaxis, surgical technique, perioperative care, and treatment of comorbid conditions can significantly reduce and potentially eliminate fistulae in laryngectomy patients who are especially at risk.

Original languageEnglish (US)
Pages (from-to)927-934
Number of pages8
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume153
Issue number6
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

Fingerprint

Laryngectomy
Fistula
Perioperative Care
Antibiotic Prophylaxis
Tertiary Care Centers
Medical Records
Diabetes Mellitus
Neck
Radiotherapy
Head
Radiation

Keywords

  • head and neck cancer surgery
  • laryngectomy
  • pharyngocutaneous fistula
  • quality and performance improvement
  • radiation
  • surgical complications

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Surgery

Cite this

Reduction of pharyngocutaneous fistulae in laryngectomy patients by a comprehensive performance improvement intervention. / Li, Ryan; Zhou, Xian Chong; Fakhry, Carole; Negrin, Juan; Lee, Gregory; Ha, Patrick; Blanco, Ray; Saunders, John; Califano, Joseph A.

In: Otolaryngology - Head and Neck Surgery (United States), Vol. 153, No. 6, 01.12.2015, p. 927-934.

Research output: Contribution to journalArticle

Li, Ryan ; Zhou, Xian Chong ; Fakhry, Carole ; Negrin, Juan ; Lee, Gregory ; Ha, Patrick ; Blanco, Ray ; Saunders, John ; Califano, Joseph A. / Reduction of pharyngocutaneous fistulae in laryngectomy patients by a comprehensive performance improvement intervention. In: Otolaryngology - Head and Neck Surgery (United States). 2015 ; Vol. 153, No. 6. pp. 927-934.
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abstract = "Objective Pharyngocutaneous fistula is a common complication in laryngectomy patients, particularly in previously irradiated cases. We initiated a comprehensive performance improvement intervention in all head and neck surgery patients intended to reduce postoperative infection and fistulae rates. We report our review of outcomes within laryngectomy patients. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects Nineteen laryngectomy patients at risk of postoperative fistula formation. Methods We reviewed the medical records of all patients who had undergone laryngectomy procedures between January 2013 and April 2014. Clinicodemographic data were obtained, including history of diabetes, prior radiation therapy, type of reconstruction performed for closure of the pharyngeal defect, and the presence or absence of postoperative fistula. Results The study population comprised 19 laryngectomy patients. Prior to implementation of our performance improvement intervention, 8 of 11 (73{\%}) patients undergoing laryngectomy developed postoperative fistulae. After intervention, 0 of 8 patients developed fistulae (P =.002). Prior radiation, diabetes mellitus, and overall stage were not associated with a reduction in fistula rate (P >.05). Conclusion Comprehensive uniform application of a standard antibiotic prophylaxis, surgical technique, perioperative care, and treatment of comorbid conditions can significantly reduce and potentially eliminate fistulae in laryngectomy patients who are especially at risk.",
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