Risk Factors for Vocal Cord Paralysis and Hoarseness Following Endotracheal Intubation

Abstract

Background: Hoarseness following endotracheal intubationis a complication that may persist due to recurrent laryngeal nerve palsy, which can impair the quality of life. Here, we evaluated the risk factors for recurrent laryngeal nerve palsy following endotracheal intubation. Methods: We conducted a single-center retrospective cohort study of all surgical patients who underwent general anesthesia and intubation at St Luke’s International Hospital from January 1, 2011, to July 31, 2020. To identify risk factors for recurrent laryngeal nerve palsy following endotracheal intubation, Fisher’s exact test and t-test were used for univariate analysis, and logistic regression analysis was used for multivariate analysis. Results: Of the 46,617 eligible cases, 14 (0.03%) developed vocal cord paralysis. Multivariate analysis revealed a significant association between postoperative hoarseness (OR=42.4, 95%CI=12.8-141.0, p<0.001) and the development of vocal cord paralysis. Sub-analysis with hoarseness as the secondary outcome revealed that hypertension, cuff pressure measurements, and anesthesia time were significantly associated with the development of postoperative hoarseness. Conclusion: Understanding the risk factors for recurrent laryngeal nerve palsy in surgical patients may help to identify those at high-risk of post-intubation hoarseness and vocal cord paralysis preoperatively and intraoperatively, and allow for more targeted management during intubation.