title: Total laryngectomy with primary tracheoesophageal puncture: Intraoperative versus delayed voice prosthesis placement.
abstract: Studies support using intraoperative voice prosthesis insertion performed at the time of primary tracheoesophageal puncture (TEP) during laryngectomy. However, none have compared intraoperative voice prosthesis insertion with delayed voice prosthesis insertion. The purpose of this study was to prospectively examine patient, services, and cost benefits of intraoperative versus delayed voice prosthesis placement.
  
  
  
  Voice prosthesis use, duration to the first voice prosthesis change, early communication, and costs were compared between 14 patients who underwent a laryngectomy and who received intraoperative voice prosthesis placement, and 10 patients who underwent initial catheter stenting and then delayed voice prosthesis insertion.
  
  
  
  Intraoperative voice prosthesis placement was associated with significantly fewer early device changes (1.4 vs 2), voice prosthesis changes because of resizing (8% vs 80%), longer durations to initial voice prosthesis change (159.7 vs 24.5 days), earlier commencement of voice rehabilitation (13.2 vs 17.6 days), reduced length of hospital stay (17.2 vs 24.5 days), and cost savings of $559.83/person.
  
  
  
  Superior clinical and patient benefits are associated with intraoperative voice prosthesis placement during primary TEP. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1138-1144, 2017.
authors.affiliation: Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.
authors.forename: Rachelle A
authors.initials: RA
authors.lastname: Robinson
authors.affiliation: Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Simms
authors.affiliation: The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, Queensland, Australia.|Centre for Functioning and Health Research, Queensland Health, Buranda, Queensland, Australia.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Ward
authors.affiliation: Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.|The University of Queensland, School of Health and Rehabilitation Sciences, St. Lucia, Queensland, Australia.
authors.forename: Molly K
authors.initials: MK
authors.lastname: Barnhart
authors.affiliation: Department of Speech Pathology, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Chandler
authors.affiliation: Comprehensive Cancer Centre, Prince of Wales Hospital (POWH), Sydney, New South Wales, Australia.|The Clinical Teaching School, University of New South Wales, Kensington, New South Wales, Australia.|Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, New South Wales, Australia.
authors.forename: Robert I
authors.initials: RI
authors.lastname: Smee
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D007825:Laryngectomy / Q000379:methods / Q000534:rehabilitation*; D007831:Larynx, Artificial; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D011677:Punctures; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D013070:Speech Therapy / Q000379:methods; D018709:Statistics, Nonparametric; D013997:Time Factors; D014132:Trachea / Q000601:surgery*; D016896:Treatment Outcome; D014833:Voice Quality
keywords: communication; laryngectomy; primary puncture; tracheoesophageal speech; voice prosthesis