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Vocal Fold Paralysis/Paresis as a Marker for Poor Swallowing Outcomes After Thoracic Surgery Procedures.

Authors
  • Crowson, Matthew G1
  • Tong, Betty C2
  • Lee, Hui-Jie3
  • Song, Yao3
  • Misono, Stephanie4
  • Jones, Harrison N5
  • Cohen, Seth6
  • 1 Otolaryngology-Head & Neck Surgery, Sunnybrook Health Science Center, Toronto, ON, Canada. , (Canada)
  • 2 Surgery, Duke University Medical Center, DUMC Box 3805, Durham, NC, USA.
  • 3 Biostatistics & Bioinformatics, Duke University, Durham, NC, USA.
  • 4 Department of Otolaryngology Head & Neck Surgery, University of Minnesota, Minneapolis, MN, USA.
  • 5 Duke University Medical Center, Durham, NC, USA.
  • 6 Surgery, Duke University Medical Center, DUMC Box 3805, Durham, NC, USA. [email protected]
Type
Published Article
Journal
Dysphagia
Publication Date
Dec 01, 2019
Volume
34
Issue
6
Pages
904–915
Identifiers
DOI: 10.1007/s00455-019-09987-8
PMID: 30798360
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

(1) To examine the association between vocal fold paresis/paralysis (VFP) and poor swallowing outcomes in a thoracic surgery cohort at the population level, and (2) to assess utilization of ENT/speech-language pathology intervention in these cases. The National Inpatient Sample (NIS) represents a 20% stratified sample of discharges from US hospitals. Using ICD-9 codes, discharges undergoing general thoracic surgical procedures between 2008 and 2013 were identified in the NIS. Sub-cohorts of discharges with VFP and those who utilized ENT/SLP services were also identified. Weighted logistic regression models were used to compare binary outcomes such as dysphagia, aspiration pneumonia, and other complications; generalized linear models with generalized estimating equations (GEE) were used to compare total hospital costs and length of stay (LOS). We identified a weighted estimate of 673,940 discharges following general thoracic surgery procedures. The weighted frequency of VFP was 3738 (0.55%). Compared to those without VFP, patients who discharged with VFP had increased odds of dysphagia (6.56, 95% CI 5.07-8.47), aspiration pneumonia (2.54, 95% CI 1.74-3.70), post-operative tracheotomy (3.10, 95% CI 2.16-4.45), and gastrostomy tube requirement (2.46, 95% CI 1.66-3.64). Discharges with VFP also had a longer length of stay and total hospital costs. Of the discharges with VFP, 15.7% received ENT/SLP intervention. VFP after general thoracic procedures is associated with negative swallowing-related health outcomes and higher costs. Despite these negative impacts, most patients with VFP do not receive ENT/SLP intervention, identifying a potential opportunity for improving adverse swallowing-related outcomes.

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