A NSQIP study comparing surgical outcomes between primary and non-primary TEPs after total laryngectomy

Authors

Muhammad El Shatanofy, Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA; Department of Otolaryngology, University of Miami Hospital, Miami, FL 33136, USA. Electronic address: melshata3@gmail.com.
Emily Youner, Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA; Department of Otolaryngology, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA.
Timothy B. Shaver, Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA.
Taimur Chaudhry, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; Albany Medical College, Albany, NY 12208, USA.
Joseph Goodman, Department of Otolaryngology, George Washington University Hospital, Washington, DC 20037, USA.

Document Type

Journal Article

Publication Date

8-17-2023

Journal

American journal of otolaryngology

Volume

45

Issue

1

DOI

10.1016/j.amjoto.2023.104026

Keywords

NSQIP; Post-surgical complications; Total laryngectomy (TL); Tracheoesophageal prosthesis (TEP)

Abstract

OBJECTIVE: Tracheoesophageal puncture with voice prosthesis (TEP) is considered the gold standard for voice rehabilitation after total laryngectomy; however, there is debate as to whether it should be inserted concurrently with removal of the larynx (primary TEP), or as a separate, additional procedure at a later date (secondary TEP). We utilized the National Surgical Quality Improvement Program Database (NSQIP) to compare postoperative complications, readmission rates, and reoperation rates among individuals who underwent total laryngectomy with or without concurrent TEP placement. METHODS: We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) from 2012 to 2019. Patients were categorized into primary and non-primary TEP groups using a variation of CPT codes for total laryngectomy, tracheoesophageal prosthesis, and type of reconstruction. Univariate analyses were performed and significance was determined at p < 0.05. RESULTS: A total of 1974 patients who underwent total laryngectomy were identified from the database: 1505 (77.3 %) in the non-primary TEP group and 442 (22.7 %) in the primary TEP group. Patients in the non-primary TEP group were more likely to have an ASA class greater than or equal to three (91.2 % primary vs. 84.6 % non-primary, p < 0.001). Patients in the non-primary TEP group were also more likely to require intraoperative or postoperative blood transfusions within the first 72 h of surgery (20.5 % non-primary vs. 15.3 % primary, p = 0.016). Both groups had similar rates of wound breakdown and dehiscence. There remained no significant difference based on type of reconstruction. CONCLUSIONS: This study suggests that patients receiving primary TEPs are not at a greater risk of developing wound complications such as pharyngocutaneous fistulas in the 30-day postoperative period. This remained true when patients were stratified by type of flap reconstruction. Patients in the non-primary TEP group were more likely to have an ASA category of 3 or greater, which may explain why they experienced higher rates of complications such as blood transfusions intra-operatively or post-operatively.

APA Citation

El Shatanofy, Muhammad; Youner, Emily; Shaver, Timothy B.; Chaudhry, Taimur; and Goodman, Joseph, "A NSQIP study comparing surgical outcomes between primary and non-primary TEPs after total laryngectomy" (2023). GW Authored Works. Paper 3227.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3227

Department

Surgery