Impact of Patient Factors and Management Strategies on Outcomes After Transverse Posterior Cordotomy

Abstract

Objectives/Hypothesis Carbon dioxide laser transverse posterior cordotomy (TPC) aims to improve airway aperture in patients with glottic obstruction. Postoperative complications may worsen airway compromise and necessitate additional interventions. We sought to identify factors impacting outcomes after TPC. Study Design Retrospective chart review. Methods Medical records of patients who underwent TPC for glottic airway obstruction at a tertiary‐care medical center between 2008 and 2018 were reviewed. Demographics, comorbidities, and intra‐ and postoperative management strategies were analyzed. Results Twenty patients who underwent TPC for glottic airway obstruction met inclusion criteria. The mean age was 57 years, and 13 patients were female. Mean follow‐up time was 442 days. Seven patients had posterior glottic stenosis, and 13 had bilateral vocal fold paralysis. Twelve patients developed postoperative complications including granuloma formation (four patients), hospital readmission for dyspnea due to glottic edema (five patients), need for revision surgery (nine patients), or failure to decannulate tracheotomy (five patients). Eight patients had an uncomplicated recovery with improved dyspnea, with two patients with tracheotomies decannulated. Patients with a history of smoking tobacco were more likely to experience complications (P = .035). There were no significant differences in outcomes with respect to history of head and neck radiation or gastroesophageal reflux disease. Steroid injection at the surgical site and postoperative medications did not significantly impact outcomes. With respect to granuloma formation, none of the variables analyzed reached significance. Conclusions History of tobacco use increases complication rates after TPC. Other patient comorbidities and intra‐ and postoperative management strategies do not impact outcomes. Level of Evidence 4 Laryngoscope, 131:1066–1070, 2021

Examining readmissions following outpatient microlaryngeal surgery

“…Twenty‐eight cordotomies were performed in our study, five of which resulted in readmission (18%). This rate is comparable to a study by Qazi et al where 5 out of 20 patients (25%) undergoing transverse posterior cordotomy required readmission for dyspnea 21 …”

“…where 5 out of 20 patients (25%) undergoing transverse posterior cordotomy required readmission for dyspnea. 21 Our study found current/former smoking status to be a risk factor for readmission. Similarly, in their cordotomy study, Qazi et al also found that patients with a history of smoking were found to have a higher likelihood of experiencing complications after cordotomy procedures.…”

Clinical Predictors of Postintubation Bilateral Vocal Fold Immobility

“…Prior studies have noted a relationship between smoking and tracheostomy dependence in patients with PGS, as well as poorer outcomes after surgical intervention for BVFI. 9,21 We did not elucidate a difference in tracheostomy status based on smoking history. This may be due to the fact that we described smoking as patients who had ever smoked at some point rather than as the current smoking status, since only five patients identified as current smokers.…”

Posterior Glottic Stenosis: A Review of Surgical Management Outcomes

“…It is not unusual for these patients to require multiple interventions until symptom resolution or significant improvement. [23][24][25][26] We present surgical interventions with increasing aggressiveness, which often correlates with the severity of stenosis being addressed.…”

“…Overall, they report 80% success with improvement in dyspnea and tracheostomy decannulation in a cohort of 20 patients with BVFP and PGS. 24 Arytenoidectomy is commonly performed endoscopically with the removal of the medial body of the arytenoid cartilage, widening the posterior glottic airway. A total or complete arytenoidectomy is the removal of the entire body of the arytenoid until flush with the wall of the cricoid ring.…”