Complication Trajectories in Total Pharyngolaryngectomy: Comprehensive Complication Index Analysis

Area of Science:

• Surgical oncology
• Reconstructive surgery
• Patient safety

Background:

• Total pharyngolaryngectomy with free jejunal transfer (TPL with FJT) can lead to various complications.
• Traditional complication grading systems like Clavien-Dindo do not capture the full spectrum or progression of postoperative complications.
• The Comprehensive Complication Index (CCI) offers a continuous measure for longitudinal assessment of surgical complications.

Purpose of the Study:

• To evaluate the utility of the Comprehensive Complication Index (CCI) in assessing complication trajectories following TPL with FJT.
• To identify distinct patterns of postoperative complications using a group-based trajectory model.
• To determine the predictive value of early CCI scores for subsequent severe complication courses.

Main Methods:

• Retrospective observational study of 161 patients undergoing TPL with FJT (2018-2023).
• Daily postoperative complications were tracked using CCI from postoperative day 1 to 30.
• Group-based trajectory modeling and receiver operating characteristic (ROC) curve analysis were employed.

Main Results:

• Three distinct complication trajectories were identified: no complication (n=80), moderate (n=66), and severe (n=15).
• Early CCI values predicted severe complication trajectories.
• A CCI cutoff of 8.7 on postoperative day 2 showed high predictive accuracy (AUC 0.926, 86.7% sensitivity, 93.8% specificity).

Conclusions:

• The CCI effectively categorizes complication trajectories after TPL with FJT, offering more insight than traditional grading.
• Early identification of severe complication courses using CCI facilitates targeted interventions.
• This approach can potentially improve patient outcomes following complex head and neck reconstruction.