title: Vocal Cord Paralysis After Thoracic Aortic Surgery: Incidence and Impact on Clinical Outcomes.
abstract: BACKGROUND
  Vocal cord paralysis (VCP) is a serious complication associated with thoracic aortic surgery; however, there is a paucity of literature regarding the incidence and impact of VCP on postoperative outcomes. We sought to determine the incidence of VCP and its impact on clinical outcomes in patients who underwent thoracic aortic repair at our center.
  
  
  METHODS
  A retrospective chart review was conducted on all patients who underwent thoracic aortic surgery between January 2009 and September 2012.
  
  
  RESULTS
  A total of 259 patients underwent a thoracic aortic procedure during the study period. Vocal cord paralysis was diagnosed in 12 (5%) patients, a median of 6 [3 to 21] days after extubation. The incidence was 1%, 0%, 20%, and 25% in those undergoing an open ascending, hemiarch, total arch, or descending aortic procedure, respectively. Patients with VCP had an increased incidence of pneumonia (58% vs 17%, p = 0.003), readmission to the intensive care unit for respiratory failure (17% vs 2%, p = 0.047), and longer hospital length of stay (18 [11 to 43] days versus 9 [6 to 15] days, p = 0.002). A propensity-matched analysis confirmed a higher incidence of pneumonia (58% vs 17%, p = 0.020) and longer hospital length of stay (18 [11 to 43] vs 10 [7 to 14] days, p = 0.015) in patients suffering VCP.
  
  
  CONCLUSIONS
  Vocal cord paralysis is a common complication in patients undergoing open surgery of the aortic arch and descending aorta, and is associated with significant morbidity. Further research may be warranted to determine if early fiberoptic examination and consideration of a vocal cord medialization procedure may mitigate the morbidity associated with VCP.
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Carly L
authors.initials: CL
authors.lastname: Lodewyks
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: White
authors.affiliation: Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Graham
authors.initials: G
authors.lastname: Bay
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.affiliation: Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Bella
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Barker
authors.affiliation: Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Iain
authors.initials: I
authors.lastname: Kirkpatrick
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Moon
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: epascoe@sbgh.mb.ca.
authors.forename: Edward
authors.initials: E
authors.lastname: Pascoe
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000453:epidemiology* / Q000209:etiology*