Key result
Open thoracic aortic surgery carries a ~15% incidence of vocal fold mobility impairment.
Why the study?
Postoperative vocal fold mobility impairment (VFMI) after thoracic aortic surgery is reported inconsistently because operative anatomy, outcome definitions, and postoperative ascertainment vary substantially.
Meta-Analysis (n=2,082)
Postoperative vocal fold mobility impairment occurs in approximately 14.9% of symptomatic patients undergoing open thoracic aortic reconstruction, with risk varying significantly by anatomical extent and ascertainment strategy, supporting targeted laryngeal assessment.
Answers are grounded in this paper and cite their sources.
VFMI risk warrants routine postoperative laryngeal assessment; extends instrumentally confirmed incidence synthesis for risk stratification research.
OBJECTIVES: Postoperative vocal fold mobility impairment (VFMI) after thoracic aortic surgery is reported inconsistently because operative anatomy, outcome definitions and postoperative ascertainment vary substantially. We evaluated variation in observed VFMI, its relationship with anatomical exposure and ascertainment, and its reported clinical consequences. METHODS: PubMed, Embase and MEDLINE (Ovid) were searched from inception to July 2026 for adult studies reporting VFMI after open or hybrid thoracic aortic surgery. Random-effects meta-analysis was restricted to symptom-triggered, instrumentally confirmed cohorts undergoing direct open thoracic-aortic reconstruction. Risk of bias was assessed using QUIPS and JBI guidance, and certainty using GRADE. RESULTS: Thirty-nine observational studies were included. Eleven symptom-triggered, instrumentally confirmed cohorts (2,082 patients; 263 events) contributed to the primary synthesis. Pooled observed VFMI was 14.9% (95% CI 9.4-21.5%), but heterogeneity was substantial (I² 92.7%, 95% CI 89.7-94.6%) and the 95% prediction interval was 0.3-43.3%. Study-level incidence ranged from 4.0% to 38.8%. Greater anatomical extent, particularly distal arch or descending exposure, was consistently associated with higher observed VFMI, whereas specific left-subclavian-proximate estimates were based on limited observational evidence. VFMI was also associated with pulmonary morbidity, airway intervention and prolonged hospitalisation. CONCLUSION: A single pooled incidence does not adequately describe postoperative VFMI after thoracic aortic surgery. Observed risk varies markedly with anatomical exposure and ascertainment strategy. The evidence supports targeted postoperative laryngeal assessment in symptomatic patients and highlights the need to evaluate routine screening in selected high-risk distal arch and descending procedures.
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Farooq et al. (2026) conducted a meta-analysis in Postoperative vocal fold mobility impairment after thoracic aortic surgery (n=2,082). Direct open or hybrid thoracic aortic surgery was evaluated on Postoperative vocal fold mobility impairment (VFMI) (Pooled incidence 14.9%, 95% CI 9.4-21.5%). Open thoracic aortic surgery had a 14.9% pooled incidence of vocal fold mobility impairment (95% CI 9.4-21.5%), varying widely with anatomical extent and ascertainment.
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