Patient factors associated with tracheoesophageal prosthesis complications: A retrospective TriNetX study

Sandhya Ganesan, The Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America; The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States of America. Electronic address: sganesan@mfa.gwu.edu.
Sofia A. Finestone, The Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America. Electronic address: sofiafinestone@gwmail.gwu.edu.
Sana Smaoui, Department of Hearing and Speech Sciences, Faculty of Allied Health Sciences, Kuwait University, Kuwait; Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada. Electronic address: sana.smaoui@ku.edu.kw.
Timothy Brandon Shaver, The Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America. Electronic address: timshaver11@email.gwu.edu.
Jennifer Schottler, The Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America.
Punam Thakkar, The Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America. Electronic address: pthakkar@mfa.gwu.edu.
Arjun Joshi, The Division of Otolaryngology - Head & Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America. Electronic address: ajoshi@mfa.gwu.edu.

Document Type

Journal Article

Publication Date

5-20-2025

Journal

American journal of otolaryngology

Volume

46

Issue

5

DOI

10.1016/j.amjoto.2025.104681

Keywords

Total laryngectomy; Tracheoesophageal puncture; Voice restoration

Abstract

INTRODUCTION: Tracheoesophageal puncture (TEP) with voice prothesis placement is a common method for voice restoration following total laryngectomy (TL). This study aims to determine patient factors associated with the need for more frequent TEP changes and maintenance in addition to TEP-associated complications. METHODS: Patients who underwent TEP procedure were identified in the TriNetX Research Network. Cohorts were stratified by comorbidities, including diabetes, GERD, esophageal stricture, hypo/hyperthyroidism, tobacco and alcohol use, radiation history, and primary versus secondary TEP. Kaplan-Meier analyses assessed time to prosthesis change, and risks of complications, including fistula formation, local infection, prosthesis leak, aspiration pneumonia, and dysphagia, were calculated. RESULTS: Among 4145 patients identified, diabetes was associated with increased risk of prosthesis leak and dysphagia. Hypothyroidism, GERD, and esophageal strictures were linked to higher rates of fistula formation, infection, prosthesis leak, aspiration pneumonia, and dysphagia. Primary TEP was associated with increased fistula and infection rates compared to secondary TEP. Radiation and tobacco use were significantly associated with dysphagia, and tobacco and alcohol use with higher infection and aspiration risks. Average time to TEP change was 72 days. Patients with GERD (HR 1.17, 95 % CI [1.06-1.29]) and esophageal stricture (HR 1.13, 95 % CI [1.02-1.26]) required more frequent prosthesis changes. CONCLUSIONS: Understanding factors that affect TEP function and longevity can help optimize patient selection for TEP following TL. Patients at increased risk for complications resulting in the need for more frequent TEP changes should be carefully counseled during the discussion of voicing options following TL.

Department

School of Medicine and Health Sciences Student Works

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