Abstract 4364887: Postoperative vocal cord paralysis in pediatric patients undergoing pulmonary artery reconstruction or unifocalization

Introduction: Children undergoing pulmonary artery reconstruction (PAR) surgery for multilevel PA stenosis or pulmonary atresia and major aortopulmonary collaterals (MAPCAs) are at risk for vocal cord immobility (VCI) and related complications. We sought to identify risk factors for and characterize the sequelae of postoperative VCI in this population. Research Questions: We hypothesize that patients undergoing PAR are at risk for VCI, and that VCI is associated with prolonged tube feeding and postoperative hospital stay. Methods: We collected demographic, diagnostic, operative, and early postoperative data from medical records for all patients who underwent unifocalization or PAR surgery between 2017-24. The diagnosis of VCI was ascertained from our programmatic database, and a 1:2 case:control analysis was performed to evaluate risk factors and outcomes. Patients with pre-existing VCI and those who died <20 days after surgery were excluded. Comparison between case and control patients was performed with chi-square analysis, the Wilcoxon rank sum test, and multiple logistic regression. Results: A total of 489 total patients who underwent PAR surgery met all inclusion criteria. The incidence of VCI was 16% (n=80). These 80 cases with confirmed VCI were compared with 160 randomly selected control patients who did not develop VCI. The demographic, diagnostic, and procedural variables analyzed were not significantly associated with VCI (Table 1). Compared to controls, cases with VCI had longer hospital length of stay (median 20 days {interquartile range, IQR 14-34} vs 14 days {IQR 9-24}, p=0.004) and longer ICU length of stay (median 12 days {IQR 7-12} vs 10 days {IQR 6-18}, p = 0.049). Intervention consisting of vocal cord medialization with injection laryngoplasty was performed in 54% of cases with identified VCI. Prior to surgery, 15% of cases were dependent on enteral tube for feeding, compared to 25% of controls. A postoperative swallow study confirmed aspiration in 93% of cases with VCI, who were significantly more likely to be discharged from the hospital with an enteral tube than controls (62% vs 39%, p<0.001). Conclusions: Patients undergoing PAR surgery are at relatively high risk for postoperative VCI, which is associated with prolonged ICU and total hospital length of stay and with the need for enteral feeding at discharge. Parents should be aware of these findings to help set appropriate expectations and plan for postoperative recovery.