School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia
Amy McIntosh, BN
Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia
Karen Jardine, BSpPath
Speech and Language Pathology, Queensland Children's Hospital, Brisbane, Queensland, Australia
Jessica Suna, BN, BSc, GradCer, MHlthSci
Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia
Kathryn Versluis, BSc (Health Science)
Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia
Nicola Slee, MBBS, FRACS, GAICD
Otolaryngology Head & Neck Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia
Gareth Lloyd, BMBS, BMedSci (hons), FRCS
Otolaryngology Head & Neck Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia
Robert Justo, MBBS, FRACP
School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia
Greg Merlo, BSci, MHEcon, PhD
School of Primary Health, University of Queensland, Brisbane, Queensland, Australia
Mary Wilson, BN
Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
Department of Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
Jennifer Powell, BA, BSc, MBBS, FRANZCr
Department of Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
Prem Venugopal, FRCS-CTh
School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia
Kim Betts, MBiostats, MPH, PhD
Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
Nelson Alphonso, FRCS-CTh
School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Queensland, Australia; Queensland Pediatric Cardiac Research, Centre for Children's Health Research, Brisbane, Queensland, Australia; Address for reprints: Nelson Alphonso, FRCS-CTh, Queensland Pediatric Cardiac Service, Level 7f Clinical Directorate, Queensland Children's Hospital, 501 Stanley St, South Brisbane, QLD 4101 Australia.
Objective: To determine the incidence, outcomes, and evaluate diagnostic modalities for postoperative vocal cord dysfunction (VCD) following cardiothoracic surgery in children. Methods: A prospective mixed-methods study using principles of implementation science was completed. All patients undergoing surgery involving the aortic arch, ductus, or ligamentum arteriosum and vascular rings from September 2019 to December 2020 were enrolled. Patients underwent speech pathology assessment, laryngeal ultrasound, and flexible direct laryngoscopy. Results: Ninety-five patients were eligible for inclusion. The incidence of VCD ranged from 18% to 56% and varied according to procedure group. VCD occurred in 42% of neonates. Repair of hypoplastic aortic arch was associated with increased risk of VCD (57%; P = .002). There was no significant difference in duration of intubation, pediatric intensive care unit stay, or hospital stay. Forty percent children were able to achieve full oral feeding. Children with VCD were more likely to require nasogastric supplementary feeding at discharge (60% vs 36%; P = .044). Sixty-eight percent of patients demonstrated complete resolution of VCD at a median of 97 days postoperatively. Laryngeal ultrasound and speech pathology assessment combined had a sensitivity of 91% in comparison to flexible direct laryngoscopy. Conclusions: VCD occurred in one-third and resolved in two-thirds of patients at a median of 3 months following cardiac surgery. Aortic arch repair carried the highest risk of VCD. VCD adversely influenced feeding. Forty percent of patients achieved full oral feeding before discharge. VCD did not delay intensive care unit or hospital discharge. Speech pathology assessment and laryngeal ultrasound combined was reliable for diagnosis in most patients and was more patient friendly than flexible direct laryngoscopy.
