Risk Factors for Intubation-Related Laryngeal Granulomas: A Prospective Study in Surgical Patients

This study aimed to determine the frequency of intubation-related laryngeal granulomas (ILGs) after surgery under general anesthesia and identify risk factors, with a focus on tube type and duration.

A single-center prospective cohort (November 2012-September 2013) of adults undergoing elective surgery expected to last at least 5 h with intubation was conducted. Fiberoptic laryngoscopy was performed on the day after extubation and at 1 week, 1 month, and 3 months. Candidate variables included tube type (single lumen vs. double lumen [DLT]), intubation duration, Cormack-Lehane grade, intraoperative transesophageal echocardiography (TEE), gastroesophageal reflux disease, body mass index, sex, and age. Associations were evaluated using univariate tests and multivariable logistic regression.

Forty patients were analyzed (median age, 73 years; 19 men). Cardiovascular surgery accounted for 25 of 40 cases (62.5%); DLTs were used in 6 of 40 (15.0%) and TEE in 22 of 40 (55.0%). Mucosal changes (erythema/white plaque) were observed on day 1 in 18 of 40 patients (45.0%). ILG was detected at 1 week in 10 of 40 patients (25.0%), including nine after cardiovascular surgery. Eight of 10 cases (80%) resolved spontaneously by 1 month, whereas 2 of 10 (20%) enlarged and required 2 months of inhaled steroid therapy, with complete resolution by 3 months. Univariate analysis revealed that both intubation duration ≥13 h (p = 0.014) and DLT use (p = 0.026) were significantly associated with ILG. In multivariable analysis, intubation duration ≥13 h (adjusted odds ratio [aOR]: 10.697, 95% confidence interval [CI]: 1.639-69.828; p = 0.013) and DLT use (aOR: 14.521, 95% CI: 1.531-137.680; p = 0.020) were independent risk factors.

In this cohort, ILG was detected in 25% of patients at 1 week post-extubation and typically resolved within 1 month. Prolonged intubation and DLT use were independently associated with increased ILG risk. High-risk patients - particularly those with prolonged intubation or DLT exposure - may benefit from selection of the smallest appropriate DLT when required and targeted laryngoscopy within 1 month. These findings should be interpreted cautiously, given the small sample and single-center design.