An Evaluation of Intubation-Associated Vocal Cord Dysfunction after Cardiovascular Surgery in a Single Center

Hiroki Taenaka, Sho Carl Shibata, Yuji Fujino

Department of Anaesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine

Background and Goal of Study
Intubation-associated vocal cord dysfunction (VCD) is a common complication in the perioperative period. Importantly, VCD can lead to serious respiratory complications in critically ill patients. Intubation-associated VCD may be caused by traumatic intubation, however the exact mechanism is unclear. The incidence of VCD has been reported to occur from 2 to 16% in intensive care patients. The aim of our study is to evaluate the incidence of intubation-associated VCD after cardiac surgery in our institution and identify the possible risk factors.
Materials and Methods
Institutional review board approval was attained for this study. We performed a retrospective record based review of all adult patients who underwent cardiovascular surgery at our center between January 2013 and August 2015. VCD was defined as vocal cord paralysis, subluxation, recurrent nerve paralysis, laryngeal edema, chorditis and severe hoarseness. We investigated the relationship between the incidence of VCD and history of smoking, type of surgical procedure, experience of the intubation provider, duration of surgery, and duration of intubation. A multivariate analysis was performed to identify independent risk factors.
Results
We included a total of 911 patients. After excluding patients who did not meet our criteria 756 were included for final analysis. Twenty-eight patients were diagnosed with VCD (3.7%) ; vocal cord paralysis(n=13) recurrent nerve paralysis(n=3), laryngeal edema(n=2). Fourteen patients were re-intubated and of which 8 patients required tracheostomy. The risk of VCD was increased with ventricular assist device (VAD) implantation (odds ratio [OR] 3.03; 95% confidence interval [CI] 1.18-7.75, p=0.03) and thoracic aortic aneurysm (TAA) surgery (OR 3.52, 95%CI 1.55-8.04, p<0.01). In the multivariate analysis, brachiocephalic artery repair (p=0.01) was an independent risk factor of VCD. Prolonged surgery over 6 hours (p=0.03) and long mechanical ventilation periods over 72 hours (p=0.04) were also found to increase the risk of VCD. Other factors such as smoking, experience of the intubation provider were not significant.

An evaluation of intubation-associated vocal cord dysfunction after cardiovascular surgery in a single center