Symptomatic Injury of the Recurrent Laryngeal Nerve After Cardiac Surgery in Adults

Introduction: Symptomatic paralysis of the recurrent laryngeal nerve is a little-recognized complication during cardiac surgery. Typical postoperative symptoms caused by unilateral or bilateral vocal cord paralysis include dysphonia, stridor, broncho-aspiration and dysphagia, which may affect postoperative recovery. The aim of this retrospective case-control analysis is to determine the frequency and possible risk factors associated with recurrent vocal cord paralysis and to interpret this in the context of current literature. Materials and Methods: In a retrospective analysis, patients who had undergone major heart surgery were assigned to a target group with documented new perioperative vocal cord paralysis and a control group without a corresponding “pathological” postoperative course. Results: 70 patients were identified who had a new documented vocal fold paralysis corresponding to an estimated overall incidence of perioperative recurrent laryngeal nerve palsy of 3.7%. Independently associated risk factors were redo surgery (odds ratio (OR) 10.8; p = 0.02) and aortic surgery (OR 14.7; p = 0.02). Patients with recurrent nerf palsy were intubated significantly longer compared to the control group (OR 1.3; p = 0.02). Conclusion: Vocal cord paralysis following cardiac surgery, with an incidence of 3.7%, represents a significant complication associated with increased morbidity. In addition to the prolonged intubation time, which directly impacts healthcare costs, an increasing incidence was observed after aortic replacement surgery, as in previous studies. This latter finding suggests direct intraoperative injury as a possible primary mechanism. Besides these known and partially confirmed parameters, the present analysis identifies reoperation as another specific, independent risk factor.