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Dysphagia

, Volume 34, Issue 6, pp 904–915 | Cite as

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

  • Matthew G. Crowson
  • Betty C. Tong
  • Hui-Jie Lee
  • Yao Song
  • Stephanie Misono
  • Harrison N. Jones
  • Seth CohenEmail author
Original Article

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.

Keywords

Vocal fold paralysis Esophagectomy Database analysis Speech-language pathology Deglutition Deglutition disorders 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts related to this manuscript.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Otolaryngology-Head & Neck SurgerySunnybrook Health Science CenterTorontoCanada
  2. 2.SurgeryDuke University Medical CenterDurhamUSA
  3. 3.Biostatistics & BioinformaticsDuke UniversityDurhamUSA
  4. 4.Department of Otolaryngology Head & Neck SurgeryUniversity of MinnesotaMinneapolisUSA
  5. 5.Duke University Medical CenterDurhamUSA

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