Risk Factors for Airway Complications After Thyroplasty and Arytenoid Adduction

Thyroplasty and arytenoid adduction are common phonosurgical procedures that generally have low complication rates. However, although rare, airway complications can be life-threatening, and the risk factors remain unclear.

To evaluate the short-term risks of airway obstruction and death within 14 days postoperatively associated with thyroplasty and arytenoid adduction, and to identify modifiable risk factors.

This cohort study used data from the Japanese Diagnosis Procedure Combination database to identify eligible participants from among the patients who underwent thyroplasty or arytenoid adduction from July 2010 to December 2021. Multiple regression and time-dependent Cox regression were used to assess risk factors. Data were analyzed from September 2024 to April 2025.

Thyroplasty and arytenoid adduction and potential risk factors, including antiplatelet use, gastroesophageal reflux disease, chronic pulmonary disease, and surgical procedures.

Tracheostomy, tracheal intubation, or death within 14 days postoperatively.

The analysis included 8626 patients (mean [SD] age, 60.2 [16.2] years; 3127 female [36.3%] and 5499 male [63.7%]), among whom the overall complication rate was 2.03% and the mortality rate, 0.13%. Multivariable analysis showed a clinically meaningful increase in the risk of airway complications associated with advanced age; complexity of the surgical procedure (arytenoid adduction and type III and IV thyroplasty); continuous use of antiplatelets (adjusted relative risk [aRR], 3.49; 95% CI, 1.28-9.54); resumption of antiplatelets (aRR, 2.86; 95% CI, 0.89-9.19) or anticoagulants on postoperative day 1 (aRR, 3.20; 95% CI, 0.77-13.25); presence of chronic obstructive pulmonary disease; and metastatic cancer.

These findings indicate that appropriate management of anticoagulant and antiplatelet therapy, as well as preoperative risk assessment and perioperative airway management for patients with chronic pulmonary disease may help reduce the risk of short-term airway complications after thyroplasty and arytenoid adduction. Individualized risk management in patients undergoing thyroplasty and arytenoid adduction is needed.