Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2023 Aug;176:e664-e679. doi: 10.1016/j.wneu.2023.05.117. Epub 2023 Jun 8.
Laryngeal manifestations of stroke have been sparsely described in the literature, specifically vocal fold paralysis (VFP). This study aimed to identify the prevalence, characteristics, and in-hospital outcomes of patients presenting with VFP after acute ischemic stroke (AIS) and intracranial hemorrhage (ICH).
A query of the 2000-2019 Nationwide Inpatient Sample was performed for patients admitted with AIS (International Classification of Diseases, Ninth Revision 433, 43,401, 43,411, 43,491, International Classification of Diseases, Tenth Revision I63) and ICH (International Classification of Diseases, Ninth Revision 431, 432.9, International Classification of Diseases, Tenth Revision I61, I62.9). Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or χ2 performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences > 0.1 used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for VFP on outcomes. Significance was set at an alpha level of < 0.001. All analysis were performed in R version 4.1.3.
A total of 10,415,286 patients with AIS were included; 11,328 (0.1%) had VFP. Of 2,000,868 patients with ICH 2132 (0.1%) had in-hospital VFP. Multivariable analysis revealed that patients with VFP after AIS were less likely to be discharged home (AOR 0.32; 95% confidence interval {CI}: 0.18-0.57; P < 0.001) and elevated total hospital charges (β coefficient = 59,684.6; 95% CI = 18,365.12-101,004.07; P = 0.005). Patients with VFP after ICH were less likely to experience in-hospital mortality (AOR 0.53; 95% CI: 0.34-0.79; P = 0.002) with longer hospital stays (1.99 days; 95% CI: 1.78-2.21; P < 0.001) and elevated total hospital charges (β coefficient = 53,905.35; 95% CI = 16,352.84-91,457.85; P = 0.005)..
VFP in patients with ischemic stroke and ICH; although an infrequent complication is associated with functional impairment, longer hospital stay, and higher charges.
中风的喉部表现鲜有文献记载，特别是声带麻痹（VFP）。本研究旨在确定急性缺血性中风（AIS）和颅内出血（ICH）后出现 VFP 的患者的患病率、特征和住院期间结局。
对 2000-2019 年全国住院患者样本进行查询，纳入因 AIS（国际疾病分类，第九版 433、43、401、43、411、43、491、国际疾病分类，第十版 I63）和 ICH（国际疾病分类，第九版 431、432.9、国际疾病分类，第十版 I61、I62.9）入院的患者。确定人口统计学、合并症和结局。使用 t 检验或 χ2 进行适当的单变量分析。生成 1:1 最近邻居倾向评分匹配队列。使用标准化均数差值>0.1 的变量在多变量回归中生成 VFP 对结局的调整优势比（AOR）/β 系数。设显著性水平为<0.001。所有分析均在 R 版本 4.1.3 中进行。
共纳入 10415286 例 AIS 患者，其中 11328 例（0.1%）出现 VFP。在 2000868 例 ICH 患者中，有 2132 例（0.1%）出现院内 VFP。多变量分析显示，AIS 后出现 VFP 的患者出院回家的可能性较低（AOR 0.32；95%置信区间 {CI}：0.18-0.57；P<0.001），总住院费用较高（β系数=59684.6；95%CI=18365.12-101004.07；P=0.005）。ICH 后出现 VFP 的患者院内死亡率较低（AOR 0.53；95%CI：0.34-0.79；P=0.002），住院时间较长（1.99 天；95%CI：1.78-2.21；P<0.001），总住院费用较高（β系数=53905.35；95%CI=16352.84-91457.85；P=0.005）。
缺血性中风和 ICH 患者的 VFP 虽然是一种罕见的并发症，但与功能障碍、住院时间延长和费用增加有关。
