Short-term Clinical and Economic Outcomes Associated with Vocal Fold Paralysis in Adults Undergoing Thyroidectomy: Analysis of the National Readmissions Database, 2016-2020.

OBJECTIVE

Vocal fold paralysis (VFP) is a complication of thyroidectomy associated with postoperative morbidity. However, its short-term clinical and economic effects remain underexplored. This study aimed to evaluate short-term clinical and economic outcomes associated with VFP in adults undergoing thyroidectomy.

METHODS

This retrospective cohort study included adults ≥18 years who underwent thyroidectomy between 2016 and 2020, using data from the Nationwide Readmissions Database. Patients were divided into two groups-with/without VFP. Propensity score matching (1:4) was used to balance baseline characteristics between the groups. Primary outcomes included in-hospital mortality, length of stay, total hospital charges, postoperative complications, and 30- and 90-day readmission.

RESULTS

Among 33 360 eligible patients, 1521 patients with VFP were propensity score matched to 6084 patients without VFP. VFP was significantly associated with longer length of stay (3.61 days, 95% CI: 3.06-4.17) and increased total hospital charges (USD 45 700, 95% CI: 38 120-53 280) (both P < 0.001). Patients with VFP also had significantly higher odds of multiple postoperative complications, including dysphagia, dysphonia, pneumonia, urinary tract infection, respiratory failure or mechanical ventilation, acute kidney injury, bleeding or hemorrhage, and nervous system complications (all P < 0.05). In addition, VFP was significantly associated with increased 30- and 90-day readmission, including unplanned readmission (all P < 0.001). No significant difference in in-hospital mortality was observed.

CONCLUSION

VFP following thyroidectomy is associated with greater postoperative morbidity and health care resources utilization. Preventive strategies and improved perioperative care are essential to mitigate these adverse outcomes.