Nomograms for prediction of postoperative complications in open partial laryngeal surgery

Postoperative morbidity after open partial laryngeal surgery (OPLS) may be serious, leading to a prolonged length of hospital stay and increasing costs. We sought to define the predictive factors of complications and to develop nomograms for patients eligible for OPLS based on clinical and surgical data.

We critically reviewed 535 patients with laryngeal carcinoma who underwent OPLS at our Institution from 1982 to 2007. We have identified patients affected by postoperative local, airway, dysphagia, bleeding, surgical site infection, dehiscence of pexy, emphysema, and laryngocutaneous fistula complications. We have analyzed them according to age, smoking, alcohol, tumor site, clinical T and N classification, type of OPLS and neck dissection, previous treatments. Prognostic factors were considered in a multivariate logistic regression model with backward stepwise elimination and selected to construct and design nomograms for overall and specific complications. The performance was assessed using the c-index, receiver operating characteristic, and calibration curves.

Age, clinical T classification, type of OPLS, and alcohol were related to overall (35%) and airway complications. Nomograms were built for overall, dysphagia, and airway complications.

We have developed nomograms that can identify high-risk patients undergoing OPLS and that can help to prevent severe complications and to tailor surgical planning.