An Otolaryngology-Focused Risk Stratification for Postoperative Dysphagia in Pediatric Cardiac Surgery

To develop and validate a risk stratification model for postoperative dysphagia in pediatric cardiac surgery patients, focusing on factors relevant to otolaryngologic assessment and implications for Otolaryngology management.

Analysis of 174 pediatric patients undergoing cardiac surgery at a tertiary care center between January 1, 2022 and December 31, 2023. Logistic regression was used to develop a risk score based on preoperative and intraoperative factors. Patients were categorized into low, moderate, and high-risk groups for dysphagia requiring Otolaryngology consultation. Secondary outcomes included impaired vocal fold mobility.

Of 174 patients, postoperative dysphagia necessitating Otolaryngology evaluation was identified in 102 (58.6%) children. The final predictive model included age at surgery (OR, 0.80; 95% CI, 0.72-0.90; p < 0.001), cardiopulmonary bypass duration (OR, 1.73; 95% CI, 1.23-2.45; p = 0.002), and high-risk complex procedures (e.g., Norwood) (OR, 6.49; 95% CI, 2.70-15.61; p < 0.001). Model discrimination was good (AUC 0.82). Predicted risk categories showed distinct dysphagia rates among the cohort: low-risk (24.7% of the cohort, with 30.2% experiencing dysphagia), moderate-risk (31.6%, with 38.2% experiencing dysphagia), and high-risk (43.7%, with 89.5% experiencing dysphagia). Among high-risk patients, 70.6% exhibited impaired vocal fold mobility at long-term follow-up.

This Otolaryngology-focused risk stratification model identifies pediatric cardiac surgery patients at high risk for postoperative dysphagia and associated impaired vocal fold mobility. Early identification of this population can aid consultation and therapeutic interventions like injection laryngoplasty.

Level 3.