Postoperative Vocal fold mobility impairment after thoracic aortic surgery: A systematic review and meta-analysis of incidence, anatomy, and ascertainment

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ID: 338090
2026
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Ranked #135 of 147 articles by views in Interdisciplinary CardioVascular and Thoracic Surgery

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Abstract
OBJECTIVES: Postoperative vocal fold mobility impairment (VFMI) after thoracic aortic surgery is reported inconsistently because operative anatomy, outcome definitions and postoperative ascertainment vary substantially. We evaluated variation in observed VFMI, its relationship with anatomical exposure and ascertainment, and its reported clinical consequences. METHODS: PubMed, Embase and MEDLINE (Ovid) were searched from inception to July 2026 for adult studies reporting VFMI after open or hybrid thoracic aortic surgery. Random-effects meta-analysis was restricted to symptom-triggered, instrumentally confirmed cohorts undergoing direct open thoracic-aortic reconstruction. Risk of bias was assessed using QUIPS and JBI guidance, and certainty using GRADE. RESULTS: Thirty-nine observational studies were included. Eleven symptom-triggered, instrumentally confirmed cohorts (2,082 patients; 263 events) contributed to the primary synthesis. Pooled observed VFMI was 14.9% (95% CI 9.4-21.5%), but heterogeneity was substantial (I² 92.7%, 95% CI 89.7-94.6%) and the 95% prediction interval was 0.3-43.3%. Study-level incidence ranged from 4.0% to 38.8%. Greater anatomical extent, particularly distal arch or descending exposure, was consistently associated with higher observed VFMI, whereas specific left-subclavian-proximate estimates were based on limited observational evidence. VFMI was also associated with pulmonary morbidity, airway intervention and prolonged hospitalisation. CONCLUSION: A single pooled incidence does not adequately describe postoperative VFMI after thoracic aortic surgery. Observed risk varies markedly with anatomical exposure and ascertainment strategy. The evidence supports targeted postoperative laryngeal assessment in symptomatic patients and highlights the need to evaluate routine screening in selected high-risk distal arch and descending procedures.
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Authors Omar Farooq, Eyad Jamileh, Fahad Muhammad, Alishba Nawaz, Zaheer Abbas, Georgia Layton, Mustafa Zakkar, Ibrahim Antoun
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Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag291
URL
https://doi.org/10.1093/icvts/ivag291
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