Background: Pharyngocutaneous fistula (PCF) is a significant complication that prolongs hospital stay, delays adjuvant treatment and may impair survivorship. We aimed to investigate the pre- and post-operative factors that predict PCF formation.
Methods: A review of laryngectomy, pharyngolaryngectomy and pharyngolaryngoesophagectomy patients between 2012 and 2022 at St. James’s Hospital was conducted. Descriptive statistics were presented for clinical characteristics. Logistic regression analysis was used to examine pre-operative (age, diabetes, smoker, alcohol, emergency admission, emergency tracheostomy, previous radiotherapy or chemotherapy, primary site, stage, baseline albumin, transfusion), intra-operative (procedure, flap, neck dissection, margin status, transfusion), and post-operative factors (transfusion, LRTI) associated with PCF.
Results: Of 268 patients, 178 had sufficient data for analysis, 70 with PCF. Univariable logistic regression analysis demonstrated the only factor predictive of PCF in our cohort was requirement for blood transfusion post-operatively (OR (95%): 2.8 (1.4-5.5), p<0.05). PCF was associated with a significant increase in length of stay, with a large effect size (84 vs 53 days; D: -0.76, p<0.05).
Conclusion: The strongest predictor of PCF in our cohort was anaemia requiring transfusion post-operatively. PCF remains a difficult entity predict and treat. An area for further research is whether tighter control or prophylactic treatment of anaemia would improve outcomes.
Katie Ryan, Fiona Merriman, Roisin Leahy, Conrad Timon, John Kinsella, Paul Lennon, Conall
Fitzgerald
Department of Otolaryngology, Head and Neck Surgery, St. James’s Hospital