Association of Hypothyroidism With Wound Complications Post-Laryngectomy: A Systematic Review and Meta-Analysis

Patients undergoing laryngectomy may be rendered hypothyroid following surgery or due to radiation therapy. Hypothyroidism impairs wound healing, which may increase the risk of wound complications such as pharyngocutaneous fistula (PCF). This study aims to investigate if hypothyroidism is associated with post-laryngectomy wound complications.

PubMed, Embase, Scopus, and the Cochrane Library were searched for relevant studies from database inception until January 2025.

A systematic review and meta-analysis was performed and reported according to the PRISMA guidelines. Qualitative synthesis was performed using chi-square analysis. Meta-analysis was performed using the Mantel-Haenszel method, with sensitivity analyses performed to test the robustness of our results.

Seventeen studies including 4436 patients were identified for inclusion. The mean age was 62.7 years (range 32.0-92.0 years), with 80.1% being male. This included 857 patients reported to be hypothyroid (19.3%). Meta-analysis including 13 studies demonstrated an association between hypothyroidism and pharyngocutaneous fistula formation (OR 2.85, 95% CI 1.41-5.77, p = 0.004). Sensitivity analysis of postoperative hypothyroidism demonstrated an increased risk of PCF formation (OR 7.69, 95% CI 1.97-30.11, p = 0.003; I ² 51%), while the association was not statistically significant for pre- and perioperative hypothyroidism. Additionally, hypothyroidism was associated with increased overall wound complications following laryngectomy (OR 2.48, 95% CI 1.15-5.36, p = 0.02).

Hypothyroidism is associated with an increased risk of developing post-laryngectomy wound complications. This supports routine evaluation of thyroid status in patients undergoing laryngectomy and protocols to manage perioperative hypothyroidism.

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