Vocal Fold Paralysis/Paresis as a Marker for Poor Swallowing Outcomes After Thoracic Surgery Procedures.

Vocal fold paresis or paralysis was identified from billing codes, not laryngoscopy, so some cases may be missed or miscoded. The coded prevalence of 0.55% contrasts with previously reported rates of 6 to 31%, likely because this study used billing codes rather than laryngoscopy. The database is inpatient only, so vocal fold paresis or paralysis diagnosed after discharge would not be counted. The database cannot tell whether patients had vocal fold paresis or paralysis before surgery, or how severe their lung cancer was, so other factors may explain worse swallowing outcomes. It cannot show whether ENT or speech-language pathology services caused shorter stays, lower costs, or better swallowing; it only records whether services were billed. The reported ENT/SLP service rate may be an underestimate because consults without a billable encounter may not appear. The results report 18.1% weighted ENT/SLP services, but the conclusion reports 15.7% intervention, so the exact rate is unclear.

No conflicts of interest were declared. The paper is categorized as having NIH extramural research support.

Do not read the longer stay and higher cost among discharges with ENT/SLP services as evidence that these services caused worse outcomes. The study did not explain why services were requested, so this association cannot be taken as a treatment effect.