Our Summary

The researchers aimed to figure out how often patients who have undergone heart or chest surgery end up with problems moving their vocal folds (the parts of the throat that help us speak), what factors contribute to this, and how it affects their health afterwards. They used a special camera to look at the throats of adults who had recently had such surgery. They also took note of any relevant information about the patients and the surgeries they had undergone, and evaluated their health outcomes.

They found that 25% of the 185 patients they examined had problems moving their vocal folds, with most of these issues being on the left side. There were also a variety of throat injuries, including growths, swelling, bruising, and bleeding. The researchers determined that the risk of having complete vocal fold mobility problems was higher for patients who had a specific type of heart surgery (aortic arch procedure), for those with a body mass index less than 25, and for African-American or Hispanic patients. Patients with two or more of these risk factors were much more likely to have vocal fold mobility problems.

Moreover, patients with complete vocal fold mobility issues had a higher risk of pneumonia, needing to be put back on a ventilator, dying, and staying in the hospital longer, which also increased the cost of their care.

The researchers recommend that medical teams pay special attention after surgery to those patients who are at high risk, including examining their throats, to catch any problems early and improve the patients’ outcomes.

FAQs

  1. What is the incidence of vocal fold mobility impairment (VFMI) in postoperative cardiovascular patients?
  2. What are the independent risk factors for complete VFMI after cardiovascular surgery?
  3. How does VFMI impact the health outcomes of postoperative cardiovascular patients?

Doctor’s Tip

One helpful tip a doctor might tell a patient about vocal cord surgery is to follow postoperative care instructions carefully, including voice rest and avoiding activities that could strain the vocal cords. It is also important to attend follow-up appointments with a laryngologist to monitor vocal fold mobility and address any potential issues early on. Additionally, maintaining good overall health, including proper hydration and avoiding smoking or excessive alcohol consumption, can support optimal healing after vocal cord surgery.

Suitable For

Patients who are typically recommended vocal cord surgery are those who have vocal fold mobility impairment (VFMI) as a result of surgical procedures such as sternotomy or thoracotomy. Risk factors for VFMI include undergoing an aortic arch procedure, having a body mass index less than 25, and being of African-American or Hispanic race. Patients with complete VFMI have higher odds of complications such as pneumonia, reintubation, and death, as well as increased length of hospital stay and cost of care. Early detection and interdisciplinary postoperative care are recommended for high-risk patients to improve outcomes.

Timeline

Before vocal cord surgery:

  1. Patient undergoes sternotomy or thoracotomy procedure.
  2. Patient is intubated during surgery.
  3. Within 72 hours of extubation, patient undergoes a fiberoptic laryngoscopy examination to assess vocal fold mobility.
  4. Potential demographic and surgical risk factors are collected.
  5. Laryngologist assesses vocal fold mobility and mucosal injury.

After vocal cord surgery:

  1. Incidence of vocal fold mobility impairment (VFMI) is determined, with 25% of patients experiencing VFMI.
  2. Risk factors for complete VFMI include aortic arch procedure, low body mass index, and African-American or Hispanic race.
  3. Patients with complete VFMI have increased odds of complications such as pneumonia, reintubation, and death.
  4. Interdisciplinary postoperative care and laryngoscopy examination are recommended for high-risk patients to improve outcomes.

What to Ask Your Doctor

  1. What is vocal cord surgery and why do I need it?
  2. What are the potential risks and complications of vocal cord surgery?
  3. How long is the recovery period after vocal cord surgery?
  4. Will I need speech therapy or other rehabilitation after vocal cord surgery?
  5. What are the success rates of this type of surgery?
  6. Are there any alternative treatments or procedures that could be considered instead of surgery?
  7. How will vocal cord surgery impact my ability to speak and swallow?
  8. Will I need to follow any specific post-operative care instructions or restrictions?
  9. What can I expect in terms of long-term outcomes and potential complications?
  10. Are there any specific factors in my medical history that may affect the success of vocal cord surgery?

Reference

Authors: Plowman EK, Chheda N, Anderson A, Dallal York J, DiBiase L, Vasilopoulos T, Arnaoutakis G, Beaver T, Martin T, Bateh T, Jeng EI. Journal: Ann Thorac Surg. 2021 Jul;112(1):53-60. doi: 10.1016/j.athoracsur.2020.07.074. Epub 2020 Oct 17. PMID: 33075318