Author(s)
Emily Kwon, BA
Saharsh Talwar, BS
Sofie Wong
Wayne Hsueh, MD
Rachel Kaye, MD FACS
Affiliation(s)
Rutgers New Jersey Medical School
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe how vocal fold paralysis subtypes and comorbidities, particularly cardiac conditions, influence hospitalization outcomes.
Objectives: To evaluate how subtypes of vocal fold paralysis/paresis (VFP) influence pediatric inpatient healthcare utilization and outcomes
Study Design: Retrospective cross-sectional analysis.
Methods: Using 2003-2019 Kids' Inpatient Database, we compared hospitalization characteristics between vocal fold complication subgroups: unilateral paresis, unilateral paralysis, bilateral paresis, and bilateral paralysis. We compared subgroup demographic factors and adjusted for cardiac comorbidities. Groups were then compared for region, seasonality, hospital charges, length of stay (LOS), and mortality using frequency functions and multivariate analyses.? Data analyses were performed using R studio version 4.5.0.
Results: 11,115 unweighted cases were identified. Unilateral paresis was most common (69.4%), followed by unilateral paralysis (14.7%), bilateral paresis (13.2%), and bilateral paralysis (2.7%). Most patients were <1 year old (46.5%). Paralysis was associated with significantly higher charges than paresis (+$34,103.33, p=0.007), while bilateral VFP had lower charges than unilateral (-$81,089.19, p<0.001). Cardiac comorbidities were associated with higher costs (+$113,797.38, p<0.001) and unilateral VFP. LOS and cost remained significantly associated with VFP subtype after adjustment. Mortality was rare (N=162) and not associated with VFP type (p=0.7986). The South was associated with unilateral paresis, while bilateral paresis was more common in the Midwest.
Conclusions: Differences in cost and resource use across VFP subtypes suggest variable clinical management. The strong association of cardiac comorbidities with both unilateral VFP and higher costs underscores the need for tailored care approaches in this population.