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Plowman EK, Chheda N, Anderson A, Dallal York J, DiBiase L, Vasilopoulos T, Arnaoutakis G, Beaver T, Martin T, Bateh T, Jeng EI. Vocal Fold Mobility Impairment After Cardiovascular Surgery: Incidence, Risk Factors, and Sequela. Ann Thorac Surg 2020; 112:53-60. [PMID: 33075318 DOI: 10.1016/j.athoracsur.2020.07.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/13/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We aimed to determine the incidence and contributing risk factors of vocal fold mobility impairment (VFMI) in postoperative cardiovascular patients and evaluate the impact of VFMI on health-related outcomes. METHODS This single-site prospective study enrolled adults undergoing sternotomy or thoracotomy procedures who underwent a fiberoptic laryngoscopy examination within 72 hours of extubation. Potential demographic and surgical risk factors and health-related outcomes were collected. A blinded laryngologist assessed VFMI and mucosal injury. Descriptives, univariate and multivariable regression analyses with odds ratios (OR) were performed. RESULTS Of 185 eligible examinations, VFMI was confirmed in 25% of patients (7 complete, 39 partial VFMI) with left-sided involvement in 83% of cases. Laryngeal mucosal injury included granuloma (38%), posterior cricoid hypertrophy (37%), edema (29%), bruising (23%), and hemorrhage (9%). Independent risk factors for complete VFMI were aortic arch procedure (odds ratio 6.1), body mass index less than 25 (OR: 7.2), and African-American or Hispanic race (OR: 6.0). Patients with two or more identified risk factors had a 33.0 increased odds of complete VFMI compared with patients not having two or more risk factors. Compared with patients having normal vocal fold motion, patients with complete VFMI had a 2.7 increased odds of pneumonia, 5.7 higher odds of reintubation, a 7.3 times higher odds of death, and increased length of hospital stay and cost of care (P < .05). CONCLUSIONS Interdisciplinary postoperative care and laryngoscopy examination are recommended for high-risk patients to facilitate early detection and improve patient outcomes.
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Affiliation(s)
- Emily K Plowman
- Aerodigestive Research Core, University of Florida, Gainesville, Florida; Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida; Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
| | - Neil Chheda
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Amber Anderson
- Aerodigestive Research Core, University of Florida, Gainesville, Florida; Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida
| | - Justine Dallal York
- Aerodigestive Research Core, University of Florida, Gainesville, Florida; Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida
| | - Lauren DiBiase
- Aerodigestive Research Core, University of Florida, Gainesville, Florida; Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida
| | | | - George Arnaoutakis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Thomas Beaver
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Tomas Martin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Tamara Bateh
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Eric I Jeng
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida
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