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

Published

Journal Article

(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.

Full Text

Duke Authors

Cited Authors

  • Crowson, MG; Tong, BC; Lee, H-J; Song, Y; Misono, S; Jones, HN; Cohen, S

Published Date

  • December 2019

Published In

Volume / Issue

  • 34 / 6

Start / End Page

  • 904 - 915

PubMed ID

  • 30798360

Pubmed Central ID

  • 30798360

Electronic International Standard Serial Number (EISSN)

  • 1432-0460

Digital Object Identifier (DOI)

  • 10.1007/s00455-019-09987-8

Language

  • eng

Conference Location

  • United States