Advertisement
Original Research| Volume 36, ISSUE 1, P208-214, January 2022

Download started.

Ok

Clinical and Financial Outcomes Associated With Vocal Fold Paralysis in Congenital Cardiac Surgery

Published:March 08, 2021DOI:https://doi.org/10.1053/j.jvca.2021.03.008

      Objectives

      Vocal fold paralysis (VFP) has proven to increase resource use in several surgical fields. However, its burden in congenital cardiac surgery, a specialty known to be associated with high resource use, has not yet been examined. The authors aimed to assess the impact of VFP on costs, lengths of stay, and readmissions following congenital cardiac surgery.

      Design

      A retrospective analysis of administrative data.

      Setting

      The 2010-2017 National Readmissions Database.

      Participants

      All pediatric patients undergoing congenital cardiac surgery.

      Interventions

      None.

      Measurements and Main Results

      Vocal fold paralysis was defined using International Classification of Diseases, Ninth and Tenth Revisions, diagnosis codes. The primary outcome of interest was 30-day nonelective readmissions and 90-day readmissions; costs, length of stay, and discharge status also were considered. Of an estimated 124,486 patients meeting study criteria, 2,868 (2.3%) were identified with VFP. Incidence of VFP increased during the study period (0.7% in 2010 to 3.2% in 2017, nptrend < 0.001). Rates of nonhome discharge (30.0% v 16.4%, p < 0.001), 30-day readmission (23.9% v 12.4%, p < 0.001), and 90-day readmission (8.3% v 4.4%, p = 0.03) were increased in the VFP cohort, as were lengths of stay (42.1 v 27.0 days, p < 0.001) and costs ($196,000 v $128,000, p < 0.001). After adjustment for patient and hospital factors, VFP was independently associated with greater odds of nonhome discharge (adjusted odds ratios [AOR], 1.66, 95% CI, 1.14-2.40), 30-day readmission (AOR, 1.58, 95% CI, 1.03-2.42), 90-day readmission (AOR, 2.07, 95% CI, 1.22-3.52), longer lengths of stay (+ 6.1 days, 95% CI, 1.3-10.8), and higher hospitalization costs (+$22,000, 95% CI, 3,000-39,000).

      Conclusions

      Readmission rates after congenital cardiac surgery are significantly greater among those with VFP, as are costs, lengths of stay, and nonhome discharges. Therefore, further efforts are necessary to increase awareness and reduce the incidence of VFP in this vulnerable population to minimize the financial burden of congenital cardiac surgery on the US medical system.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hornik CP
        • He X
        • Jacobs JP
        • et al.
        Complications after the Norwood operation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
        Ann Thorac Surg. 2011; 92: 1734-1740
        • Benavidez OJ
        • Gauvreau K
        • Del Nido P
        • et al.
        Complications and risk factors for mortality during congenital heart surgery admissions.
        Ann Thorac Surg. 2007; 84: 147-155
        • Connor JA
        • Gauvreau K
        • Jenkins KJ.
        Factors associated with increased resource utilization for congenital heart disease.
        Pediatrics. 2005; 116: 689-695
        • Pasquali SK
        • Jacobs ML
        • He X
        • et al.
        Variation in congenital heart surgery costs across hospitals.
        Pediatrics. 2014; 133: e553-e560
        • Jabbour J
        • Uhing M
        • Robey T.
        Vocal fold paralysis in preterm infants: Prevalence and analysis of risk factors.
        J Perinatol. 2017; 37: 585-590
        • Truong MT
        • Messner AH
        • Kerschner JE
        • et al.
        Pediatric vocal fold paralysis after cardiac surgery: Rate of recovery and sequelae.
        Otolaryngol. 2007; 137: 780-784
        • Pourmoghadam KK
        • DeCampli WM
        • Ruzmetov M
        • et al.
        Recurrent laryngeal nerve injury and swallowing dysfunction in neonatal aortic arch repair.
        Ann Thorac Surg. 2017; 104: 1611-1618
        • Ambrose SE
        • Ongkasuwan J
        • Dedhia K
        • et al.
        Analysis of vocal fold motion impairment in neonates undergoing congenital heart surgery.
        JAMA Otolaryngol Head Neck Surg. 2018; 144: 406-412
        • Zuckerman RB
        • Sheingold SH
        • Orav EJ
        • et al.
        Readmissions, observation, and the hospital readmissions reduction program.
        N Engl J Med. 2016; 374: 1543-1551
      1. Agency for Healthcare Research and Quality. Nationwide HCUP databases. Available at: www.hcup-us.ahrq.gov/databases.jsp. Accessed March 22, 2021.

        • Welke KF
        • Shen I
        • Ungerleider RM.
        Current assessment of mortality rates in congenital cardiac surgery.
        Ann Thorac Surg. 2006; 82: 164-171
        • Sanaiha Y
        • Khoubian JJ
        • Williamson CG
        • et al.
        Trends in mortality and costs of pediatric extracorporeal life support.
        Pediatrics. 2020; 146e20193564
        • Quan H
        • Li B
        • Couris CM
        • et al.
        Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.
        Am J Epidemiol. 2011; 173: 676-682
        • Charlson M
        • Szatrowski TP
        • Peterson J
        • et al.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • Jenkins KJ.
        Risk adjustment for congenital heart surgery: The RACHS-1 method.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004; 7: 180-184
      2. Jacobs ML, Pasquali SK, Jacobs JP, et al. An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. The Journal of thoracic and cardiovascular surgery, 145, 2013, 1046-1057.

      3. Cuzick J.A Wilcoxon-type test for trend. Stat Med1985;4:87-90.

      4. StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.

      5. Richter AL, Ongkasuwan J, Ocampo EC.Long-term follow-up of vocal fold movement impairment and feeding after neonatal cardiac surgery. Int J Pediatr Otorhinolaryngol 2016;83:211-4.

        • Benjamin JR
        • Smith PB
        • Cotten CM
        • et al.
        Long-term morbidities associated with vocal cord paralysis after surgical closure of a patent ductus arteriosus in extremely low birth weight infants.
        J Perinatol. 2010; 30: 408-413
        • Jabbour J
        • Martin T
        • Beste D
        • et al.
        Pediatric vocal fold immobility: Natural history and the need for long-term follow-up.
        JAMA Otolaryngol Head Neck Surg. 2014; 140: 428-433
        • Kempny A
        • Dimopoulos K
        • Uebing A
        • et al.
        Outcome of cardiac surgery in patients with congenital heart disease in England between 1997 and 2015.
        PLoS One. 2017; 12e0178963
        • Takano S
        • Nito T
        • Tamaruya N
        • et al.
        Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis.
        Auris Nasus Larynx. 2012; 39: 597-600
        • Gorantla SC
        • Chan T
        • Shen I
        • et al.
        Current epidemiology of vocal cord dysfunction after congenital heart surgery in young infants.
        Pediatr Crit Care Med. 2019; 20: 817-825
        • Crowson MG
        • Tong BC
        • Lee HJ
        • et al.
        Vocal fold paralysis/paresis as a marker for poor swallowing outcomes after thoracic surgery procedures.
        Dysphagia. 2019; 34: 904-915
        • Orzell S
        • Joseph R
        • Ongkasuwan J
        • et al.
        Outcomes of vocal fold motion impairment and dysphagia after pediatric cardiothoracic surgery: A systematic review.
        Otolaryngol Head Neck Surg. 2019; 161: 754-763
        • Naunheim MR
        • Song PC
        • Franco RA
        • et al.
        Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.
        Laryngoscope. 2017; 127: 691-697
        • Li Y
        • Garrett G
        • Zealear D.
        Current treatment options for bilateral vocal fold paralysis: A state-of-the-art review.
        Clin Exp Otorhinolaryngol. 2017; 10: 203-212
        • Sedaghat S
        • Tapia M
        • Fredes F
        • et al.
        Endoscopic management of bilateral vocal fold paralysis in newborns and infants.
        Int J Pediatr Otorhinolaryngol. 2017; 97: 13-17
        • Rutter MJ
        • Hart CK
        • de Alarcon A
        • et al.
        Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis.
        Laryngoscope. 2018; 128: 257-263
        • Nguyen S
        • Zhu A
        • Toppen W
        • et al.
        Dysphagia after cardiac operations is associated with increased length of stay and costs.
        Am Surg. 2016; 82: 890-893
        • Kogon B
        • Jain A
        • Oster M
        • et al.
        Risk factors associated with readmission after pediatric cardiothoracic surgery.
        Ann Thorac Surg. 2012; 94: 865-873
        • Markham JL
        • Hall M
        • Gay JC
        • et al.
        Length of stay and cost of pediatric readmissions.
        Pediatrics. 2018; 141e20172934
        • Francis DO
        • Sherman AE
        • Hovis KL
        • et al.
        Life experience of patients with unilateral vocal fold paralysis.
        JAMA Otolaryngol Head Neck Surg. 2018; 144: 433-439
        • Dewan K
        • Cephus C
        • Owczarzak V
        • et al.
        Incidence and implication of vocal fold paresis following neonatal cardiac surgery.
        Laryngoscope. 2012; 122: 2781-2785
        • Lawlor CM
        • Zendejas B
        • Baird C
        • et al.
        Intraoperative recurrent laryngeal nerve monitoring during pediatric cardiac and thoracic surgery: A mini review.
        Front Pediatr. 2020; 8587177
        • Kim J
        • Graves CE
        • Jin C
        • et al.
        Intraoperative nerve monitoring is associated with a lower risk of recurrent laryngeal nerve injury: A national analysis of 17,610 patients.
        Am J Surg. 2021; 221: 472-477
        • Strychowsky JE
        • Rukholm G
        • Gupta MK
        • et al.
        Unilateral vocal fold paralysis after congenital cardiothoracic surgery: A meta-analysis.
        Pediatrics. 2014; 133: e1708-e1723