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01-05-2018 | Head and Neck Oncology

Hypothyroidism and Wound Healing After Salvage Laryngectomy

Authors: Andrew J. Rosko, MD, Andrew C. Birkeland, MD, Emily Bellile, MS, Kevin J. Kovatch, MD, Ashley L. Miller, MD, Craig C. Jaffe, MD, Andrew G. Shuman, MD, Steven B. Chinn, MD, Chaz L. Stucken, MD, Kelly M. Malloy, MD, Jeffrey S. Moyer, MD, Keith A. Casper, MD, Mark E. P. Prince, MD, Carol R. Bradford, MD, Gregory T. Wolf, MD, Douglas B. Chepeha, MD, Matthew E. Spector, MD

Published in: Annals of Surgical Oncology | Issue 5/2018

Abstract

Background

Patients undergoing salvage laryngectomy are predisposed to radiation-induced hypothyroidism and impaired wound healing secondary to the tissue effects of prior treatment. The impact of hypothyroidism on postoperative wound healing is not established.

Methods

A single-institution retrospective case series was performed. The inclusion criteria specified preoperatively euthyroid adults who underwent salvage laryngectomy with concurrent neck dissection between 1997 and 2015 for persistent or recurrent laryngeal squamous cell carcinoma after radiation or chemoradiation therapy (n = 182). The principal explanatory variable was postoperative hypothyroidism, defined as thyroid-stimulating hormone (TSH) higher than 5.5 mIU/L. The primary end points of the study were pharyngocutaneous fistulas and wounds requiring reoperation. Multivariate analysis was performed.

Results

The fistula rate was 47% among hypothyroid patients versus 23% among euthyroid patients. In the multivariate analysis, the patients who experienced hypothyroidism in the postoperative period had a 3.6-fold greater risk of fistula [95% confidence interval (CI) 1.8–7.1; p = 0.0002]. The hypothyroid patients had an 11.4-fold greater risk for a required reoperation (24.4 vs 5.4%) than the euthyroid patients (95% CI 2.6–49.9; p = 0.001). The risk for fistula (p = 0.003) and reoperation (p = 0.001) increased with increasing TSH. This corresponds to an approximate 12.5% incremental increase in the absolute risk for fistula and a 10% increase in the absolute risk for reoperation with each doubling of the TSH.

Conclusion

Postoperative hypothyroidism independently predicts postoperative wound-healing complications. The association of hypothyroidism with fistula formation may yield opportunities to modulate wound healing with thyroid supplementation or to provide a biomarker of wound progression.

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Title: Hypothyroidism and Wound Healing After Salvage Laryngectomy
Authors: Andrew J. Rosko, MD
Andrew C. Birkeland, MD
Emily Bellile, MS
Kevin J. Kovatch, MD
Ashley L. Miller, MD
Craig C. Jaffe, MD
Andrew G. Shuman, MD
Steven B. Chinn, MD
Chaz L. Stucken, MD
Kelly M. Malloy, MD
Jeffrey S. Moyer, MD
Keith A. Casper, MD
Mark E. P. Prince, MD
Carol R. Bradford, MD
Gregory T. Wolf, MD
Douglas B. Chepeha, MD
Matthew E. Spector, MD
Publication date: 01-05-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-017-6278-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hypothyroidism and Wound Healing After Salvage Laryngectomy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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