Karsten Rebecca Tosca, Timmermans Adriana Jacquelina, Ten Cate Julia, Stuiver Martijn Matthias, van den Brekel Michiel Wilhelmus Maria
a Department of Head and Neck Surgery , Antoni van Leeuwenhoek Nederlands Kanker Instituut , Amsterdam , The Netherlands.
Acta Otolaryngol. 2018 Dec;138(12):1128-1135. doi: 10.1080/00016489.2018.1515497. Epub 2019 Jan 27.
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.
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.
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.
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.
The study provides an overview of direct postoperative complications after TL.
在荷兰癌症研究所（NCI），全喉切除术后（TL）的患者会被收治入重症监护病房（ICU）。
评估全喉切除术后的直接并发症以及入住ICU的必要性。
对在NCI接受全喉切除术的患者术后24小时内发生的需要ICU治疗的事件进行回顾。通过多变量逻辑分析评估预定风险因素的预测价值。确定所得模型分配的风险评分的最佳阈值。
113例患者中有25例（22%）发生了事件，其中72%包括去甲肾上腺素依赖。风险分析表明，全喉切除术前接受过同步放化疗（CRT）或进行过包括咽部重建的手术或两者皆有的患者应入住ICU。将该规则应用于该队列，57例患者（50%）术后将被送往病房，其中7例（12%）发生了需要ICU治疗的事件。
相当一部分患者在全喉切除术后24小时内发生了事件。我们基于上述风险因素对患者进行的风险分层不够准确。
该研究概述了全喉切除术后的直接术后并发症。
