Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Brazilian Journal of Otorhinolaryngology |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942015000400394 |
Resumo: | INTRODUCTION: Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery.METHODS: A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n = 171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed.RESULTS: American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed.CONCLUSION: A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement. |
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Brazilian Journal of Otorhinolaryngology |
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Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomyPostoperative complicationsENT surgical proceduresLaryngeal neoplasmsLaryngectomySurgical wound dehiscenceSalivary gland fistulaINTRODUCTION: Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery.METHODS: A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n = 171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed.RESULTS: American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed.CONCLUSION: A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.2015-08-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942015000400394Brazilian Journal of Otorhinolaryngology v.81 n.4 2015reponame:Brazilian Journal of Otorhinolaryngologyinstname:Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)instacron:ABORL-CCF10.1016/j.bjorl.2014.09.009info:eu-repo/semantics/openAccessCecatto,Suzana BoltesMonteiro-Soares,MatildeHenriques,TeresaMonteiro,EuricoMoura,Carla Isabel Ferreira Pintoeng2015-09-02T00:00:00Zoai:scielo:S1808-86942015000400394Revistahttp://www.bjorl.org.br/https://old.scielo.br/oai/scielo-oai.phprevista@aborlccf.org.br||revista@aborlccf.org.br1808-86861808-8686opendoar:2015-09-02T00:00Brazilian Journal of Otorhinolaryngology - Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF)false |
dc.title.none.fl_str_mv |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
title |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
spellingShingle |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy Cecatto,Suzana Boltes Postoperative complications ENT surgical procedures Laryngeal neoplasms Laryngectomy Surgical wound dehiscence Salivary gland fistula |
title_short |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
title_full |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
title_fullStr |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
title_full_unstemmed |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
title_sort |
Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy |
author |
Cecatto,Suzana Boltes |
author_facet |
Cecatto,Suzana Boltes Monteiro-Soares,Matilde Henriques,Teresa Monteiro,Eurico Moura,Carla Isabel Ferreira Pinto |
author_role |
author |
author2 |
Monteiro-Soares,Matilde Henriques,Teresa Monteiro,Eurico Moura,Carla Isabel Ferreira Pinto |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Cecatto,Suzana Boltes Monteiro-Soares,Matilde Henriques,Teresa Monteiro,Eurico Moura,Carla Isabel Ferreira Pinto |
dc.subject.por.fl_str_mv |
Postoperative complications ENT surgical procedures Laryngeal neoplasms Laryngectomy Surgical wound dehiscence Salivary gland fistula |
topic |
Postoperative complications ENT surgical procedures Laryngeal neoplasms Laryngectomy Surgical wound dehiscence Salivary gland fistula |
description |
INTRODUCTION: Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery.METHODS: A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n = 171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed.RESULTS: American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed.CONCLUSION: A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-08-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942015000400394 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1808-86942015000400394 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1016/j.bjorl.2014.09.009 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. |
publisher.none.fl_str_mv |
Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. |
dc.source.none.fl_str_mv |
Brazilian Journal of Otorhinolaryngology v.81 n.4 2015 reponame:Brazilian Journal of Otorhinolaryngology instname:Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF) instacron:ABORL-CCF |
instname_str |
Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF) |
instacron_str |
ABORL-CCF |
institution |
ABORL-CCF |
reponame_str |
Brazilian Journal of Otorhinolaryngology |
collection |
Brazilian Journal of Otorhinolaryngology |
repository.name.fl_str_mv |
Brazilian Journal of Otorhinolaryngology - Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF) |
repository.mail.fl_str_mv |
revista@aborlccf.org.br||revista@aborlccf.org.br |
_version_ |
1754575991655628800 |