A national analysis of outcomes associated with laryngeal complications among older adults undergoing cardiac surgery

Introduction: Laryngeal complications (LC) or dysphagia are often underdiagnosed among those undergoing cardiac surgery. With conflicting reports on the relevance of LC, we characterized the prevalence, risk factors, and outcomes of this complication in a national cohort of older adults receiving cardiac surgery across the U.S. Methods: Adults (≥65 years) receiving coronary, valvular and proximal aortic operations were tabulated from the 2016-2022 Nationwide Readmissions Database. Patients were stratified by the concomitant diagnosis of LC. Mixed regression models were developed to identify the association of LC with outcomes of interest. Results: < 0.001), more frequently female (31.9 vs 30.1%, P < 0.001) and insured by Medicare (88.6 vs 86.8%, P < 0.001).Following risk adjustment, LC was associated with greater odds of mortality (Adjusted Odds Ratio [AOR] 1.23, 95% Confidence Interval [CI] 1.06-1.55), respiratory (AOR 1.72, 95% CI 1.61-1.83), and infectious complications (AOR 1.51, 95% CI 1.41-1.62). LC was also associated with greater length of stay (β +5.43 days, 95% CI 5.09-5.78), hospitalization costs (β + $17,600, 95% CI 16,100-19,100), and 30-day non-elective readmission (AOR 1.30, 95% CI 1.22-1.39). Conclusions: LC appears to be associated with increased mortality, postoperative complications, and 30-day readmissions. Furthermore, LC is linked with an incremental increase in length of stay and hospitalization expenditures. While causality could not be established, our findings suggest the relevance of early detection and potential interventions to mitigate sequelae of LC in older patients.