Leveraging large language models to audit perioperative total laryngectomy care: anesthetic, nutritional, and complication profiles in a real‑world cohort

Clinical Snapshot

Key Findings

• P Value: Not applicable (descriptive study)

• Effect Size: Complication rate 22.5%, pharyngocutaneous fistula rate 12.5%

• Primary Outcome: Perioperative care patterns and complications in total laryngectomy patients

• Nnt Or Sensitivity: Zero in-hospital mortality, 2.3% overall mortality at 12 months

• Confidence Interval: Not provided

Clinical Application

Enteral nutrition protocols and multimodal analgesia approaches are feasible in Australian centres Results may inform Australian head and neck cancer care protocols; VTE prophylaxis rates (65%) below recommended standards suggest need for protocol optimisation in line with ANZCA guidelines Patients undergoing total laryngectomy for advanced laryngeal cancer in tertiary centres

Abstract

<p><strong>Introduction: </strong>Total laryngectomy (TL) remains the standard treatment for advanced la‑ ryngeal cancer, and its perioperative management requires close collaboration within a multidisciplinary team, including anaesthesiologists and clinical nutritionists.</p><p><strong>Aim:</strong> The aim of this study was to analyse the perioperative course of patients un‑ dergoing TL from both an anaesthesiologist's and a nutritionist's perspective, with a particular focus on the feasibility and performance of structured data extraction from electronic medical records using large language models (LLMs).</p><p><strong>Material and methods:</strong> We performed a single‑centre retrospective analysis of 43 consecutive patients undergoing TL (ICD‑9 codes 30.32, 30.39, 30.41, 30.49) be‑ tween January 2024 and April 2026. Clinical data, including physician notes (n = 845), nursing notes (n = 2578), discharge summaries (n = 173), and consultations (n = 123), were subjected to structured extraction using large language models (gemma-3-31Bit/gemma-4-26B-it). Demographics, tumour stage, length of stay (LOS), periopera‑ tive nutrition, pharmacotherapy, postoperative complications, temporal laboratory trends, and rehabilitation were analysed.</p><p><strong>Results: </strong>The cohort comprised 35 men (81%) and 8 women (19%), with a mean age of 66.4 9.8 years; pT4a (49%) and pN0 (82%) predominated. Median LOS was 15.0 days (IQR 13.1-16.5). Enteral nutrition via nasogastric tube was used in 95% of patients, and oral intake was initiated at a median of postoperative day 13. Multimodal anal‑ gesia based on intravenous paracetamol (60%), ketoprofen (47%), and metamizole (40%) was routinely employed, while strong opioids were used in only 5% of pa‑ tients. Postoperative complications occurred in 22.5% of cases, with pharyngocuta‑ neous fistula (PCF) being the most frequent (12.5%). In‑hospital mortality was 0%, and overall mortality during a median 12‑month follow‑up was 2.3%. CRP peaked on postoperative day 3 (mean 114 mg/L). Pharmacologic VTE prophylaxis was admi‑ nistered in 65% of patients.</p><p><strong>Conclusions:</strong> In TL patients, enteral feeding forms the backbone of nutritional sup‑port, and multimodal analgesia provides effective pain control, whereas VTE pro‑phylaxis and other modifiable elements of perioperative care warrant optimization within prehabilitation and ERAS-based protocols.</p><p> </p&gt.

References

1. 1.Zając, B., Wierzbicka, M., Jeziorny, M., Zalewska, K., & Jędruchniewicz, N. (2026). Leveraging large language models to audit perioperative total laryngectomy care: anesthetic, nutritional, and complication profiles in a real‑world cohort. Otolaryngologia polska, Article 42178846. https://doi.org/10.5604/01.3001.0055.7302