Incidence, Risk Factors, and Outcomes of Vocal Fold Mobility Impairment After Lung Transplantation

Vocal fold mobility impairment (VFMI) is an understudied complication following lung transplantation. Understanding the risk factors associated with VFMI is crucial for improving patient management and outcomes.

A retrospective chart review was conducted on all patients who underwent lung transplantation at an academic center between February 2020 and June 2024. Demographic data, comorbidities, post-operative complications, and swallowing examination data was collected. Wilcoxon rank sum tests, univariable, and multivariable logistic regression were used in analysis.

A total of 392 patients were included in the study. Of these, 107 (27.3%) patients had VFMI observed on post-operative swallowing exam. Of the patients with VFMI, 27 (25.2%) had complete immobility and 80 (74.8%) had partial immobility. Female sex (odds ratio [OR] 2.06), age at transplant (OR 0.96), length of initial intubation (OR = 2.33), and tracheostomy during transplant admission (OR = 3.29) were significant predictors of VFMI on univariable analysis. In multivariable analysis to control for demographics, comorbidities, and surgical factors, only length of intubation (OR = 1.20) remained a significant risk factor of VFMI. Rates of abnormal swallowing and aspiration pneumonia were higher in the VFMI cohort compared to the non-VFMI cohort (p < 0.001 and p = 0.044, respectively). Patients with VFMI had prolonged hospital and intensive care unit (ICU) stays (p < 0.001).

This study highlights risk factors for VFMI in lung transplant patients. Results emphasize the need for diligent post-operative evaluation and adequate outpatient follow-up.