Complication Trajectories in Total Pharyngolaryngectomy: Comprehensive Complication Index Analysis.

Background: Understanding the trajectory of complications following total pharyngolaryngectomy (TPL) with free jejunal transfer (FJT) is crucial for enhancing patient management and improving surgical outcomes. However, the traditional Clavien-Dindo classification captures only the highest grade of complication and is unable to capture the progression of complications, limiting its utility for longitudinal assessments. This study utilized the comprehensive complication index (CCI) to provide a continuous evaluation of complications over time.

Methods: This retrospective observational study included patients who underwent TPL with FJT between 2018 and 2023. Daily postoperative complications were tracked using the CCI, calculated from postoperative day 1 to day 30. A group-based trajectory model was employed to classify patterns of change in daily CCI. The predictive power of early CCI for a subsequent serious complication course was evaluated using receiver operating characteristic curve analysis.

Results: The trajectory modeling for a total of 161 eligible patients identified three distinct complication trajectories: no complication (n = 80), moderate (n = 66), and severe (n = 15). Initial CCI values were predictive of the severe complication course: a cutoff value of 8.7 for the CCI on postoperative day 2 provided an area under the curve of 0.926 with 86.7% sensitivity and 93.8% specificity.

Conclusions: Complication trajectories after TPL with FJT can be effectively categorized using the CCI, providing insights beyond the traditional grading systems. Early identification of the severe complication course allows for targeted interventions that may improve patient outcomes.

Level of evidence: 3: