Predictors of wound complications after laryngectomy: A study of over 2000 patients.
OBJECTIVE
To identify risk factors for and the rate of wound complications after laryngectomy in a large, prospectively collected national dataset, and to generate a predictive model. Study design We used the National Surgical Quality Improvement Program (NSQIP) registry created by the Department of Veterans Affairs (VA) to identify patients undergoing total laryngectomy from 1989 to 1999 (n = 2063). We linked these data to inpatient and outpatient VA administrative records to capture data for prior radiation. Over 20 preoperative and intraoperative risk factors were analyzed using bivariate techniques. Those significant at the P < 0.01 level were analyzed with logistic regression and conjunctive consolidation to identify independent predictors of wound complications.


RESULTS
The overall wound complication rate was 10.0%. In adjusted analyses, prolonged operative time (>10 hours, odds ratio = 2.10, 95% confidence interval: 1.32-3.36), exposure to prior radiation therapy (OR =1.63, 1.07-2.46), presence of diabetes (OR =1.78, 1.04-3.04), preoperative hypoalbuminemia (OR =1.90, 1.32-2.74), anemia (OR =1.59, 1.07-2.36), and thrombocytosis (OR =1.48, 1.04-2.10) were independently associated with postoperative wound complications. A prognostic model using three variables-prior radiation therapy, diabetes, and hypoalbuminemia-provided excellent risk stratification into three tiers (6.3%, 13.7%, 21.7%).


CONCLUSIONS
Preoperative radiation, prolonged operative time, low albumin, and diabetes were independently associated with postoperative wound infections. These results will help to identify patients at risk for wound complications, thus allowing for heightened surveillance and preventive measures where possible.
Schwartz
Seth R
SR
University of Washington Medical Center, Seattle, WA 98195, USA. schwarsr@u.washington.edu
Yueh
Bevan
B
Maynard
Charles
C
Daley
Jennifer
J
Henderson
William
W
Khuri
Shukri F
SF
D048909:Diabetes Complications; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D007822:Laryngeal Neoplasms / Q000150:complications / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology