Emily K Plowman1, Neil Chheda2, Amber Anderson3, Justine Dallal York3, Lauren DiBiase3, Terrie Vasilopoulos4, George Arnaoutakis5, Thomas Beaver5, Tomas Martin5, Tamara Bateh5, Eric I Jeng5. 1. 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. Electronic address: eplowman@phhp.ufl.edu. 2. Department of Otolaryngology, University of Florida, Gainesville, Florida. 3. Aerodigestive Research Core, University of Florida, Gainesville, Florida; Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida. 4. Aerodigestive Research Core, University of Florida, Gainesville, Florida. 5. Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida.
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.
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.
Authors: Clayton Prakash Burruss; Robin B Pappal; Michael A Witt; Christopher Harryman; Syed Z Ali; Matthew L Bush; Mark A Fritz Journal: Laryngoscope Investig Otolaryngol Date: 2022-07-13