Perioperative factors related to the severity of vocal cord paralysis after thoracic cardiovascular surgery

Abstract

BACKGROUNDVocal cord paralysis (VCP) is a rare complication of thoracic cardiovascular surgery. In severe cases, life-threatening airway obstruction may occur.OBJECTIVETo evaluate the incidence and severity of VCP among patients who underwent thoracic cardiovascular surgery and to identify possible risk factors.DESIGNSingle-centre retrospective review of adult patients.SETTINGOsaka University Hospital, Suita, Japan, from January 2013 to August 2015.PATIENTSWe included 688 patients in the final analysis. Preoperative, intraoperative and postoperative data were collected from medical records. Patients with preoperative VCP or tracheostomy prior to extubation were excluded. The VCP severity in relation to functional recovery was graded using the following categories: absent; mild, remission at 6 months; moderate, partial or persistent VCP at 6 months; or severe, airway obstruction after extubation requiring reintubation. An otolaryngologist diagnosed all VCP cases.MAIN OUTCOME MEASURESThe incidence and severity of VCP after extubation.RESULTSThe incidence (number) of VCP was 4.7% (32), with those of mild, moderate and severe VCP being 1.7% (12), 1.5% (10) and 1.5% (10), respectively. The ICU stay was significantly longer in patients with severe VCP than in patients without VCP [12.5 days (interquartile range 5.5 to 25.5) vs. 3 days (interquartile range 2 to 5), P = 0.0002]. In our multivariable analysis, type 2 diabetes mellitus [odds ratio (OR) 1.853, P = 0.009], intubation period (OR per 24 h 1.136, P = 0.014), ascending aortic arch surgery with brachiocephalic artery reconstruction (OR 8.708, P < 0.001) and ventricular assist device implantation (OR 3.460, P = 0.005) were independent predictors for VCP.CONCLUSIONThe identification of these risk factors may facilitate screening for VCP before extubation and possibly help anaesthesia personnel to be prepared to treat VCP-related airway obstruction should it occur.

Risk factors and outcomes of vocal cord paralysis after lung transplantation - a retrospective cohort study

“…It could be argued that our results regarding diabetes mellitus as a risk for VCP, do not dispute current data. Although not statistically significant, prevalence of diabetes was low at 18% in our cohort compared to 38% reported by Taenaka et al [2].…”

“…Regarding specific risk factors for VCP, previous studies have identified duration of intubation, diabetes mellitus and specific thoracic procedures such as implantation of ventricular assist devices and aortic arch repair . The contribution of the minimally invasive surgical approach used at our centre to VCP development cannot be assessed in this study and comparative data from centres using primarily the clamshell technique is currently lacking.…”

“…Although not statistically significant, prevalence of diabetes was low at 18% in our cohort compared to 38% reported by Taenaka et al . .…”

“…In other cardiothoracic procedures, VCP has been associated with early intensive care postoperative morbidity and mortality . Of the 35 ICU deaths during the observation period, two‐thirds ( n = 23) died intubated on mechanical ventilation, where VCP was inconsequential regarding outcome.…”

“…Vocal cord paralysis (VCP) following recurrent laryngeal nerve injury is a known complication in cardiothoracic surgery and may also occur following LTx. VCP is associated with increased length of stay, risk of pneumonia and risk of ICU readmission . It also causes recurrent aspiration .…”