TY - JOUR
T1 - Laryngopharyngeal dysfunction independent of vocal fold palsy in infants after aortic arch interventions
AU - Davies, Ryan R
AU - Carver, Stephanie W.
AU - Schmidt, Richard
AU - Keskeny, Heather
AU - Hoch, Jeanine
AU - Pizarro, Christian
PY - 2014/8
Y1 - 2014/8
N2 - Objective Laryngopharyngeal dysfunction contributes significantly to morbidity, length of stay, and increased resource utilization after aortic arch interventions in infants. Previous studies have focused on postoperative evaluation of selected symptomatic patients with vocal fold palsy (VFP). A prospective evaluation of laryngopharyngeal function was undertaken to assess and determine its importance in perioperative management. Patients and methods A routine preoperative and postoperative assessment was done by flexible fiber optic laryngoscopy, oral feeding evaluation (OFE), and modified barium swallow (mBS) on 101 infants undergoing 113 procedures on the aortic arch (2003 to 2011). The primary outcome was the ability to take full nutrition orally at discharge. Results Preoperative OFE was abnormal in 33.3% of patients. VFP occurred in 39.3%, 30 of 57 patients had an abnormal OFE. Factors predictive of abnormal postoperative feeding evaluation included genetic syndromes (odds ratio [OR], 5.1; confidence interval [CI], 1.1-23.2) and preoperative mechanical ventilation (OR, 24.1; 95% CI, 2.5-226.6). An abnormal postoperative OFE was highly predictive (OR, 7.0; 95% CI, 1.8-27.1) of an abnormal postoperative mBS. There was a trend toward decreased long-term survival among patients who were intubated or had an abnormal preoperative feeding evaluation (P =.07). Conclusions Postoperative laryngopharyngeal dysfunction is common among infants undergoing aortic arch interventions, and is largely independent of vocal fold function. Preoperative evaluation demonstrates significant intrinsic abnormalities in sensory and motor function. Routine, comprehensive, multimodality preoperative and postoperative evaluation is required to identify at-risk children and reduce morbidity and resource utilization.
AB - Objective Laryngopharyngeal dysfunction contributes significantly to morbidity, length of stay, and increased resource utilization after aortic arch interventions in infants. Previous studies have focused on postoperative evaluation of selected symptomatic patients with vocal fold palsy (VFP). A prospective evaluation of laryngopharyngeal function was undertaken to assess and determine its importance in perioperative management. Patients and methods A routine preoperative and postoperative assessment was done by flexible fiber optic laryngoscopy, oral feeding evaluation (OFE), and modified barium swallow (mBS) on 101 infants undergoing 113 procedures on the aortic arch (2003 to 2011). The primary outcome was the ability to take full nutrition orally at discharge. Results Preoperative OFE was abnormal in 33.3% of patients. VFP occurred in 39.3%, 30 of 57 patients had an abnormal OFE. Factors predictive of abnormal postoperative feeding evaluation included genetic syndromes (odds ratio [OR], 5.1; confidence interval [CI], 1.1-23.2) and preoperative mechanical ventilation (OR, 24.1; 95% CI, 2.5-226.6). An abnormal postoperative OFE was highly predictive (OR, 7.0; 95% CI, 1.8-27.1) of an abnormal postoperative mBS. There was a trend toward decreased long-term survival among patients who were intubated or had an abnormal preoperative feeding evaluation (P =.07). Conclusions Postoperative laryngopharyngeal dysfunction is common among infants undergoing aortic arch interventions, and is largely independent of vocal fold function. Preoperative evaluation demonstrates significant intrinsic abnormalities in sensory and motor function. Routine, comprehensive, multimodality preoperative and postoperative evaluation is required to identify at-risk children and reduce morbidity and resource utilization.
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U2 - 10.1016/j.jtcvs.2013.05.054
DO - 10.1016/j.jtcvs.2013.05.054
M3 - Article
C2 - 24290573
AN - SCOPUS:84904664348
SN - 0022-5223
VL - 148
SP - 617-624.e2
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -