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Patients undergoing cardiac surgeries, such as coronary artery bypass (CABG) and valve operations, are usually informed that there may be some risk of laryngeal complications that could result in a dysphonia or dysphagia. This may be due to factors including injury to the recurrent laryngeal nerve, vagus nerve or other laryngeal structures, endotracheal intubation or direct impact of surgical dissection. But how common are laryngeal complications and which factors are associated with increased or decreased likelihood of developing this complication? The authors of this paper used large data (national readmissions database - NRD) which provides information on US hospitalisation discharges and readmissions. They captured all relevant ICD codes (for CABG and valve surgery) between 2010-2017. Laryngeal complications were identified with ICD-10 codes for vocal cord palsy/paresis, dysphagia/aphagia and dysphonia/aphonia. Over the time window, the estimated number of patients was 2,319,628. An average of 1.7% were diagnosed with perioperative laryngeal complications, rising from 1.5% in 2010 to 1.8% in 2017. The authors found that there was a greater likelihood of laryngeal complications in women [OR 1.08, CI 1.04-1.12], older individuals and those with more complex surgery [OR 1.51, CI 1.36-1.67] based on adjusted odds. Although the presence of laryngeal complications did not impact mortality, it was associated with increased risk of pneumonia, tracheostomy and readmission. This incurred an average cost increase around $24,000 per patient. In addition to providing helpful estimates on incidence/prevalence of laryngeal complications after cardiac surgery, this paper showcases a useful methodology for using large datasets. Whilst this is a US-based study, it may be possible to replicate elsewhere and for other conditions.

Incidence and Outcomes of Laryngeal Complications Following Adult Cardiac Surgery: A National Analysis.
Verma A, Hadaya J, Tran Z,
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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