Composite Immunonutritional Risk Score for Predicting Pharyngocutaneous Fistula After Total Laryngectomy

Background: Pharyngocutaneous fistula (PCF) remains a notoriously frequent and clinically burdensome issue following total laryngectomy, taking a particularly heavy toll on salvage surgery cases and high-risk patients. While clinicians widely suspect that poor immunonutritional status derails normal wound healing and slows recovery, its precise capacity to predict upcoming PCF development is not yet firmly established. Aim: We aimed to evaluate how preoperative immunonutritional profiles relate to PCF occurrence after total laryngectomy, while testing if a newly designed composite immunonutritional risk score could serve as a practical predictive tool. Materials and Methods: We conducted a retrospective cohort analysis, initially screening 120 patients operated on between 2020 and 2025. Applying strict exclusion criteria left us with a final group of 43 patients. These individuals were split into three groups: early PCF (15 days), late PCF (>15 days), or fistula-free controls. We checked several preoperative markers, including the Prognostic Nutritional Index (PNI), Hemoglobin, Albumin, Lymphocyte, and Platelet Score (HALP), serum albumin, Controlling Nutritional Status Score (CONUT), and Nutritional Risk Index (NRI). After running non-parametric tests to compare the groups, we used clinically relevant cut-offs to build our composite risk score. Results Looking at the entire initial cohort, PCF developed in 19 out of 120 patients (15.8%). When we compared the early PCF group directly against primary surgery patients, we found stark differences in PNI (p=0.004), HALP (p=0.028), albumin (p=0.014), and the composite risk score (p<0.001). ROC analysis pointed to optimal cut-offs of PNI <51.07, albumin <39.7 g/L, and HALP <30.37. Ultimately, this composite score was tightly linked to fistula development (p=0.002), meaning that higher scores directly signaled a greater risk of fistula formation. Conclusion: A poor immunonutritional state before surgery strongly sets the stage for PCF after total laryngectomy. Combining PNI, HALP, and albumin into a single composite model offers a straightforward, reliable way to stratify patient risk and optimize care before stepping into the operating room.