TY - JOUR
T1 - Reduction of pharyngocutaneous fistulae in laryngectomy patients by a comprehensive performance improvement intervention
AU - Li, Ryan J.
AU - Zhou, Xian Chong
AU - Fakhry, Carole
AU - Negrin, Juan
AU - Lee, Gregory
AU - Ha, Patrick
AU - Blanco, Ray
AU - Saunders, John
AU - Califano, Joseph A.
N1 - Publisher Copyright:
© Official journal of the American Academy of Otolaryngology-Head and Neck Surgery Foundation.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - 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.
AB - 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.
KW - head and neck cancer surgery
KW - laryngectomy
KW - pharyngocutaneous fistula
KW - quality and performance improvement
KW - radiation
KW - surgical complications
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U2 - 10.1177/0194599815613294
DO - 10.1177/0194599815613294
M3 - Article
C2 - 26519459
AN - SCOPUS:84948759430
SN - 0194-5998
VL - 153
SP - 927
EP - 934
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 6
ER -