title: Reduction of Pharyngocutaneous Fistulae in Laryngectomy Patients by a Comprehensive Performance Improvement Intervention.
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.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Li
authors.affiliation: Department of Oncology-Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Xian Chong
authors.initials: XC
authors.lastname: Zhou
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.affiliation: Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Negrin
authors.affiliation: Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ha
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
authors.forename: Ray
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA.
authors.forename: John
authors.initials: J
authors.lastname: Saunders
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, USA jcalifano@ucsd.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Califano
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017577:Cutaneous Fistula / Q000517:prevention & control*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000517:prevention & control*; D011183:Postoperative Complications; D011878:Radiotherapy / Q000009:adverse effects; D016156:Respiratory Tract Fistula / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: head and neck cancer surgery; laryngectomy; pharyngocutaneous fistula; quality and performance improvement; radiation; surgical complications