title: Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience.
abstract: OBJECTIVE
  Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition.
  
  
  METHODS
  A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus.
  
  
  RESULTS
  The incidence of post-operative vocal cord paralysis was 1.1% (32 out of 3036 patients; 95% confidence interval: 0.7-1.5%). The majority were left-sided injuries (71%). Overall rate of recovery was 61% with a median time of 10 months in those who recovered, and a total follow up of 46 months. Due to feeding complications, 45% of patients required gastrostomy tube after the injury, and these patients were found to have longer duration of post-operative days of intubation (median 10 vs. 5 days, p = 0.03), ICU length of stay (50 vs. 8 days, p = 0.002), and hospital length of stay (92 vs. 41 days, p = 0.01). No pre-operative variables were identified as predictive of recovery or need for gastrostomy placement.
  
  
  CONCLUSIONS
  Recurrent laryngeal nerve injury is a serious complication of congenital heart surgery that impacts post-operative morbidity, in some cases leading to a need for further intervention, in particular, gastrostomy tube placement. A prospective, multi-center study is needed to fully evaluate factors that influence severity and time to recovery.
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Fahad A
authors.initials: FA
authors.lastname: Alfares
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Conor F
authors.initials: CF
authors.lastname: Hynes
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Ghedak
authors.initials: G
authors.lastname: Ansari
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Reginald
authors.initials: R
authors.lastname: Chounoune
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Manelle
authors.initials: M
authors.lastname: Ramadan
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Conner
authors.initials: C
authors.lastname: Shaughnessy
authors.affiliation: Department of Otolaryngology, Children's National Health System, Washington, DC, United States.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Reilly
authors.affiliation: Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.affiliation: Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States.
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
keywords: Congenital heart surgery; Gastrostomy tube; Recurrent laryngeal nerve injury; Vocal cord paralysis