{Reference Type}: Journal Article
{Title}: Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival.
{Author}: Jacobs D;Kafle S;Earles J;Rahmati R;Mehra S;Judson BL;
{Journal}: Laryngoscope Investig Otolaryngol
{Volume}: 6
{Issue}: 1
{Year}: Feb 2021
{Factor}: 2.542
{DOI}: 10.1002/lio2.441
{Abstract}: <B>OBJECTIVE: </B>To investigate factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and to analyze its effect on short-term and long-term overall survival (OS).<BR><B>METHODS: </B>The National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with laryngeal cancer, who received TL within 60 days of diagnosis, and who had an inpatient LOS ≥1 night. Multivariable binary logistic regression and survival analyses on propensity score matched cohorts with Kaplan-Meier analysis and extended Cox regression were utilized.<BR><B>RESULTS: </B>Eight thousand two hundred and ninety-eight patients from the NCDB were included. Median inpatient LOS was 8 days after TL (IQR: 7, 12). Prolonged LOS was defined as above the 75th percentile or 13 days or greater. On multivariable analysis, increasing patient age (OR 1.14 per 10 years, P = .003), female sex (OR 1.35, P < .001), and Charlson-Deyo comorbidity score of ≥2 compared to a score of 0 (OR 1.43, P < .001) were associated with prolonged LOS. Patients treated at high surgical case volume centers had a decreased likelihood for prolonged LOS (OR 0.67, P < .001). Ninety-day mortality increased over time in patients who stayed ≥13 days. Prolonged LOS was independently associated with worse OS on multivariable analysis (HR 1.40, 95% CI: 1.22, 1.61) in a matched cohort.<BR><B>CONCLUSIONS: </B>Prolonged LOS after TL serves as a strong indicator for postoperative long-term mortality and may help identify patients who warrant closer surveillance.<BR><B>METHODS: </B>3.