What are the factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and what is the effect of LOS on short-term and long-term overall survival (OS)?
BOTTOM LINE: Prolonged LOS after TL is a strong indicator for postoperative long-term mortality and may help identify patients who warrant closer surveillance.
BACKGROUND: Upfront TL in patients with laryngeal cancer is associated with long-term morbidity. Inpatient LOS is a predictor of complications in complex operations like TL. To date, studies have not investigated differences in complications or assessed long-term survival outcome measures for patients with prolonged inpatient LOS who have received TL.
STUDY DESIGN: Retrospective data analysis.
SETTING: Division of Otolaryngology, Yale University School of Medicine, New Haven, Conn.
SYNOPSIS: To test the hypothesis that there are demographic, clinical, and oncologic factors associated with, and predictive of, prolonged LOS, researchers identified 8,298 patients (6,696 males, 1,612 females, mean age 62 years) in the National Cancer Database who had laryngeal cancer, were seen between 2004 and 2016, received TL within 60 days of diagnosis, and had an inpatient LOS of > one night. The median LOS among the patients was eight days; researchers defined prolonged LOS as 13 days. On multivariable analysis, researchers found that increasing patient age, female sex, and Charlson-Deyo comorbidity scores of >2 compared to a score of 0 were all associated with prolonged LOS. Ninety-day mortality increased over time in patients who stayed >13 days. Overall, prolonged LOS was independently associated with worse long-term OS, suggesting that perioperative complications beget complications down the line of recovery. Study limitations included a lack of specific comorbidity codes or comorbidities in accessed databases and potential selection bias.
CITATION: Jacobs D, Kafle S, Earles J, et al. Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival. Laryngoscope Investig Otolaryngol. 2020;6:94-102.