Reduction of Pharyngocutaneous Fistulae in Laryngectomy Patients by a Comprehensive Performance Improvement Intervention

• Published in: Otolaryngology-head and neck surgery Vol. 153; no. 6; pp. 927 - 934
• Main Authors: Li, Ryan J., Zhou, Xian Chong, Fakhry, Carole, Negrin, Juan, Lee, Gregory, Ha, Patrick, Blanco, Ray, Saunders, John, Califano, Joseph A.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-12-2015
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Cutaneous Fistula - prevention & control; Diabetes Complications; Female; head and neck cancer surgery; Humans; laryngectomy; Laryngectomy - adverse effects; Laryngectomy - methods; Male; Middle Aged; Pharyngeal Diseases - prevention & control; pharyngocutaneous fistula; Postoperative Complications; quality and performance improvement; radiation; Radiotherapy - adverse effects; Respiratory Tract Fistula - prevention & control; surgical complications; Treatment Outcome; surgical complications; pharyngocutaneous fistula; head and neck cancer surgery; radiation; laryngectomy; quality and performance improvement
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599815613294

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.