Trends and In-Hospital Outcomes in Patients with Vocal Fold Paralysis after Ischemic and Intracerebral Hemorrhagic Stroke: A Propensity Matched 20-Year Analysis of the Nationwide Inpatient Sample

Abstract

Laryngeal manifestations of stroke have been sparsely described in the literature, specifically vocal fold paralysis (VFP). This study aimed to identify the prevalence, characteristics, and in-hospital outcomes of patients presenting with VFP after acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). A query of the 2000-2019 Nationwide Inpatient Sample was performed for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63) and ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for VFP on outcomes. Significance set at an alpha level of <0.001. All analysis performed in R version 4.1.3. A total of 10,415,286 patients with AIS were included; 11,328 (0.1%) had VFP. Of 2,000,868 patients with ICH 2,132 (0.1%) had in-hospital VFP. Multivariable analysis revealed that patients with VFP after AIS were less likely to be discharged home (AOR 0.32; 95%CI: 0.18-0.57; p<0.001) and elevated total hospital charges (β coefficient=59,684.6; 95%CI=18,365.12-101,004.07;p=0.005). Patients with VFP after ICH were less likely to experience in-hospital mortality (AOR 0.53; 95%CI: 0.34-0.79; p=0.002) with longer hospital stays (1.99 days; 95%CI: 1.78-2.21; p<0.001) and elevated total hospital charges (β coefficient=53,905.35; 95%CI=16,352.84-91,457.85;p=0.005) CONCLUSION: Vocal fold paralysis in patients with ischemic stroke and ICH; although an infrequent complication, is associated with functional impairment, longer hospital stay, and higher charges.