Reactive Thrombocytosis as a Predictor of Salivary Leak Following Total Laryngectomy: A Multi‐Institutional Retrospective Cohort Study

BACKGROUND: Pharyngocutaneous fistula (PCF) is a common complication after total laryngectomy (TL) that increases healthcare utilization and delays recovery. We hypothesized that thrombocytosis acts as a surrogate marker for PCF development. METHODS: Multi-institutional retrospective cohort study of TL patients stratified by PCF status. Demographics, perioperative platelet counts, length of stay (LOS), discharge destination and 30-day readmissions were compared. RESULTS: A total of 228 patients were identified (82 'leak,' 146 'no leak'). There were no significant differences in age, gender, BMI, smoking history, prior radiation or preoperative platelet counts. Patients who developed PCF had higher peak platelet counts, greater percent increase from baseline and later peak day. Leak risk increased with rising percent platelet change, from 18.4% among patients with a < 20% increase to 65.5% among those with a > 80% increase. PCF was also associated with longer mean LOS (13.2 vs. 8.8 days, p = 0.001), higher discharge to skilled care (37.0% vs. 17.5%, p = 0.011) and greater 30-day readmissions (47.6% vs. 14.4%, p < 0.001). CONCLUSIONS: Thrombocytosis may be an early, objective predictor of PCF. Incorporating platelet count trends into postoperative monitoring could enable earlier intervention and improve patient outcomes.