Direct complications and routine ICU admission after total laryngectomy

Abstract

Background: In the Netherlands Cancer Institute (NCI), patients are admitted to the Intensive Care Unit (ICU) after total laryngectomy (TL).

Aims/Objectives: To assess direct complications and the need for ICU admission after TL.

Material and methods: Patients who underwent a TL in the NCI were reviewed on the occurrence of an event requiring ICU treatment within the first 24 hours postoperatively. The predictive value of predetermined risk factors was assessed with multivariable logistic analysis. The optimal threshold of the risk score assigned by the resulting model was determined.

Results: An event occurred in 25 of the 113 patients (22%) of which 72% included norepinephrine dependence. Risk analysis showed that patients with either CRT prior to TL or a procedure including pharynx reconstruction, or both, should be indicated for ICU stay. Applying the rule on this cohort, 57 patients (50%) would have been sent to the ward postoperatively of which seven (12%) developed an event requiring ICU treatment.

Conclusions: A substantial proportion of the patients developed an event within the first 24 hours after TL. Our risk stratification of patients based on the mentioned risk factors is insufficiently accurate.

Significance: The study provides an overview of direct postoperative complications after TL.

背景：在荷兰癌症研究所（NCI）, 患者在全喉切除术（TL）后会被安排入住重症监护室（ICU）。

目的：检查TL术后直接并发症并评估入住ICU的必要性。

材料和方法：回顾在NCI接受TL治疗的患者术后24小时内需要ICU治疗的事件。采用多变量回归分析来检测预定危险因素的预测价值。确定了所得模式所产生的风险指数的最优阈值。

结果：113例患者中有25例（22%）出事, 其中72%出现去甲肾上腺素依赖。风险分析表明, 无论是在TL术前接受CRT治疗, 还是进行包括咽部重建在内的手术, 或两者兼而有之, 都应建议患者入住ICU。根据此规则, 57名患者（50%）将在术后被送往病房, 其中7名（12%）发生紧急情况, 需要ICU治疗。

结论：有相当一部分患者在TL术后24小时内发生紧急状况。我们基于上述风险因素对患者进行的风险分类是不够准确的。

意义：本研究提供了TL术后直接并发症的综合状况。

Keywords:

• Head and neck malignancies
• laryngectomy
• intensive care units
• postoperative complications

Disclosure statement

No potential conflict of interest was reported by the authors.

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Funding

The Netherlands Cancer Institute receives a research grant from ATOS Medical Sweden which contributes to the existing infrastructure for health-related quality of life research of the department of Head and Neck Oncology and Surgery.