Our Summary

This research paper is about the reasons why patients might need to return to the hospital after having a total laryngectomy, which is a complex surgery to remove the voice box. The researchers looked at patient records over a 12-year period to see how many had to be readmitted to the hospital within two months of their surgery.

Out of 83 patients, about one in seven (14.5%) were readmitted. The most common reasons for readmission were an infection at the surgical site and fistulas (abnormal connections or passageways between two organs or vessels).

The study also identified several factors that made a patient more likely to be readmitted. These included using tobacco, being of African ethnicity, not being married, having low levels of a protein called albumin in the blood before surgery, having high levels of thyroid-stimulating hormone (TSH) before surgery, having a high count of a type of white blood cell called neutrophils before surgery, having a higher score on a scale that measures physical health (the American Society of Anesthesiology score), and having a higher score on a scale that measures overall illness (the Cumulative Illness Rating Scale).

The authors suggest that these factors could be targeted to help reduce the number of patients who need to be readmitted to the hospital after a total laryngectomy.

FAQs

  1. What are the most common reasons for readmission after a total laryngectomy according to the study?
  2. What factors increase the likelihood of a patient being readmitted post-laryngectomy?
  3. How does the study suggest reducing the number of readmissions after a total laryngectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laryngectomy is to quit smoking. Smoking can increase the risk of complications and infections after surgery, so quitting before the procedure can help improve outcomes and reduce the likelihood of readmission to the hospital. Additionally, following post-operative care instructions, such as keeping the surgical site clean and avoiding strenuous activities, can also help prevent complications and promote healing.

Suitable For

Patients who are typically recommended for a laryngectomy are those with advanced stage laryngeal cancer that cannot be treated with other methods such as radiation or chemotherapy. Other conditions that may warrant a laryngectomy include severe benign laryngeal tumors, severe laryngeal trauma, or recurrent laryngeal papillomatosis. Additionally, patients with severe dysphagia (difficulty swallowing) or aspiration pneumonia due to laryngeal dysfunction may also be candidates for a laryngectomy. It is important for patients to discuss their individual case with their healthcare provider to determine if a laryngectomy is the best treatment option for them.

Timeline

Before laryngectomy:

  • Patient may experience difficulty breathing, swallowing, and speaking
  • Patient may undergo various tests such as imaging scans and blood tests to assess their condition
  • Patient may receive counseling and education about the surgery and post-operative care
  • Patient may undergo pre-operative preparations such as stopping smoking and adjusting medications

After laryngectomy:

  • Patient will have a temporary tracheostomy tube to help with breathing
  • Patient will receive speech therapy and counseling to learn new ways of communication such as using a voice prosthesis or electrolarynx
  • Patient will undergo regular follow-up appointments to monitor healing and adjust treatment as needed
  • Patient may experience emotional and psychological challenges such as anxiety, depression, and changes in body image
  • Patient may need to make lifestyle changes such as quitting smoking and adjusting their diet to prevent complications

Overall, the timeline for a patient before and after laryngectomy involves extensive preparation, surgery, recovery, and adjustment to a new way of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about laryngectomy include:

  1. What are the potential complications or risks associated with a total laryngectomy surgery?
  2. How long is the recovery process expected to be after a total laryngectomy?
  3. What kind of support or resources are available for patients post-surgery, such as speech therapy or support groups?
  4. How can I best care for my surgical site to prevent infection?
  5. Are there any lifestyle changes or adjustments I will need to make after a laryngectomy?
  6. What symptoms should I watch out for that may indicate a complication or the need for medical attention?
  7. Are there any specific factors about my health history or lifestyle that may impact my recovery or risk of readmission?
  8. What steps can I take to optimize my overall health before undergoing a laryngectomy surgery?
  9. What follow-up appointments or tests will be necessary after the surgery to monitor my health and recovery?
  10. Are there any specific precautions I should take to protect my airway and prevent complications after surgery?

Reference

Authors: Rammal A, Alqutub A, Alsulami O, Mozahim N, Mozahim S, Awadh M, Hakami M, AlThomali R, Mogharbel A. Journal: BMC Res Notes. 2023 Dec 20;16(1):377. doi: 10.1186/s13104-023-06645-z. PMID: 38124147