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

内容摘要

<p><strong>Introduction: </strong>Total laryngectomy (TL) remains the standard treatment for advanced la&#x2011; 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&#x2011; 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&#x2011;centre retrospective analysis of 43 consecutive patients undergoing TL (ICD&#x2011;9 codes 30.32, 30.39, 30.41, 30.49) be&#x2011; 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&#x2011; 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&#x2011; gesia based on intravenous paracetamol (60%), ketoprofen (47%), and metamizole (40%) was routinely employed, while strong opioids were used in only 5% of pa&#x2011; tients. Postoperative complications occurred in 22.5% of cases, with pharyngocuta&#x2011; neous fistula (PCF) being the most frequent (12.5%). In&#x2011;hospital mortality was 0%, and overall mortality during a median 12&#x2011;month follow&#x2011;up was 2.3%. CRP peaked on postoperative day 3 (mean 114 mg/L). Pharmacologic VTE prophylaxis was admi&#x2011; nistered in 65% of patients.</p><p><strong>Conclusions:</strong> In TL patients, enteral feeding forms the backbone of nutritional sup&#x2011;port, and multimodal analgesia provides effective pain control, whereas VTE pro&#x2011;phylaxis and other modifiable elements of perioperative care warrant optimization within prehabilitation and ERAS-based protocols.</p><p>&amp;nbsp;</p&gt.