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
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Article info
Publication history
Published online: March 08, 2021
Identification
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