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Unilateral vocal fold paralysis after congenital cardiothoracic surgery: a meta-analysis.
Pediatrics. 2014 Jun; 133(6):e1708-23.Ped

Abstract

BACKGROUND AND OBJECTIVE

There is variation in the literature in regard to the occurrence of unilateral vocal fold paralysis (UVFP) after congenital cardiothoracic surgery. The objective of this study was to identify and appraise the evidence for the occurrence of UVFP after congenital cardiothoracic surgery in a meta-analysis.

METHOD

A comprehensive search strategy in Medline, Embase, and the Cochrane Library was conducted, limited to English publications. Two independent reviewers screened studies for eligibility criteria. Of the 162 identified studies, 32 (20%) met the inclusion criteria. Using the Oxford Centre for Evidence-Based Medicine guidelines, 2 reviewers appraised the level of evidence, extracted data, and resolved discrepancies by consensus. Weighted pooled proportion and 95% confidence intervals (CIs) are reported.

RESULTS

Thirty-two studies (n = 5625 patients) were included. Levels of evidence varied from level 3 to 4. Among all studies, the weighted pooled proportion of UVFP was 9.3% (95% CI, 6.6% to 12.5%), and among 11 studies (n = 584 patients) that postoperatively evaluated patients with flexible nasopharyngolaryngoscopy to document presence of UVFP, the weighted pooled proportion of UVFP was 29.8% (95% CI, 18.5% to 42.5%). Twenty-one studies (n = 2748 patients) evaluated patients undergoing patent ductus arteriosus ligation surgery, and the weighted pooled proportion of UVFP was 8.7% (95% CI, 5.4% to 12.6%). Six of these (n = 274 patients) assessed all patients postoperatively, and the weighted pooled proportion of UVFP was 39% (95% CI, 18% to 63%). Pooled analyses of risk factors and comorbidities are reported. Heterogeneity and publication bias were detected.

CONCLUSIONS

UVFP is a demonstrated risk of congenital cardiothoracic surgery. Routine postoperative nasopharyngolaryngoscopy for vocal fold assessment by an otolaryngologist is suggested.

Authors+Show Affiliations

Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and julie.strychowsky@medportal.ca.Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; andPeterborough Regional Health Centre, Peterborough, Ontario, Canada.Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and.Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada; and.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

24843065

Citation

Strychowsky, Julie E., et al. "Unilateral Vocal Fold Paralysis After Congenital Cardiothoracic Surgery: a Meta-analysis." Pediatrics, vol. 133, no. 6, 2014, pp. e1708-23.
Strychowsky JE, Rukholm G, Gupta MK, et al. Unilateral vocal fold paralysis after congenital cardiothoracic surgery: a meta-analysis. Pediatrics. 2014;133(6):e1708-23.
Strychowsky, J. E., Rukholm, G., Gupta, M. K., & Reid, D. (2014). Unilateral vocal fold paralysis after congenital cardiothoracic surgery: a meta-analysis. Pediatrics, 133(6), e1708-23. https://doi.org/10.1542/peds.2013-3939
Strychowsky JE, et al. Unilateral Vocal Fold Paralysis After Congenital Cardiothoracic Surgery: a Meta-analysis. Pediatrics. 2014;133(6):e1708-23. PubMed PMID: 24843065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unilateral vocal fold paralysis after congenital cardiothoracic surgery: a meta-analysis. AU - Strychowsky,Julie E, AU - Rukholm,Gavin, AU - Gupta,Michael K, AU - Reid,Diane, PY - 2014/5/21/entrez PY - 2014/5/21/pubmed PY - 2014/7/31/medline KW - cardiothoracic surgery KW - patent ductus arteriosus KW - unilateral vocal fold paralysis SP - e1708 EP - 23 JF - Pediatrics JO - Pediatrics VL - 133 IS - 6 N2 - BACKGROUND AND OBJECTIVE: There is variation in the literature in regard to the occurrence of unilateral vocal fold paralysis (UVFP) after congenital cardiothoracic surgery. The objective of this study was to identify and appraise the evidence for the occurrence of UVFP after congenital cardiothoracic surgery in a meta-analysis. METHOD: A comprehensive search strategy in Medline, Embase, and the Cochrane Library was conducted, limited to English publications. Two independent reviewers screened studies for eligibility criteria. Of the 162 identified studies, 32 (20%) met the inclusion criteria. Using the Oxford Centre for Evidence-Based Medicine guidelines, 2 reviewers appraised the level of evidence, extracted data, and resolved discrepancies by consensus. Weighted pooled proportion and 95% confidence intervals (CIs) are reported. RESULTS: Thirty-two studies (n = 5625 patients) were included. Levels of evidence varied from level 3 to 4. Among all studies, the weighted pooled proportion of UVFP was 9.3% (95% CI, 6.6% to 12.5%), and among 11 studies (n = 584 patients) that postoperatively evaluated patients with flexible nasopharyngolaryngoscopy to document presence of UVFP, the weighted pooled proportion of UVFP was 29.8% (95% CI, 18.5% to 42.5%). Twenty-one studies (n = 2748 patients) evaluated patients undergoing patent ductus arteriosus ligation surgery, and the weighted pooled proportion of UVFP was 8.7% (95% CI, 5.4% to 12.6%). Six of these (n = 274 patients) assessed all patients postoperatively, and the weighted pooled proportion of UVFP was 39% (95% CI, 18% to 63%). Pooled analyses of risk factors and comorbidities are reported. Heterogeneity and publication bias were detected. CONCLUSIONS: UVFP is a demonstrated risk of congenital cardiothoracic surgery. Routine postoperative nasopharyngolaryngoscopy for vocal fold assessment by an otolaryngologist is suggested. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/24843065/Unilateral_vocal_fold_paralysis_after_congenital_cardiothoracic_surgery:_a_meta_analysis_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=24843065 DB - PRIME DP - Unbound Medicine ER -