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Background <p>Postoperative hoarseness is a common complaint following endotracheal intubation. Arytenoid dislocation (AD) is a structural injury that, if unrecognized, can lead to prolonged voice impairment. This study aimed to identify independent risk factors for AD using routinely collected perioperative variables.</p> Methods <p>This retrospective cohort study included adult patients who underwent general anesthesia with endotracheal intubation at a single institution between January 2022 and December 2024. Patients with documented postoperative hoarseness were included. Demographic, surgical, and anesthetic data were collected. Univariate analysis was followed by multivariable logistic regression to identify independent risk factors for AD. To address potential overfitting due to the limited number of AD events (n = 29), we performed a bootstrap internal validation with 1,000 resamples (bias‑corrected accelerated method).</p> Results <p>Among 101,204 intubated patients, 141 had documented postoperative hoarseness, and 87 were included after exclusions. Among patients referred for persistent postoperative hoarseness, AD was confirmed in 29 patients (33.3%), with an overall incidence of 0.03%. Multivariable analysis identified nasogastric tube or transesophageal echocardiography probe use (adjusted OR = 13.68; 95% CI: 2.088–89.619; <i>P</i> = 0.006) as an independent risk factor for AD. A secondary finding was that intraoperative head/neck positioning showed a positive association in the primary analysis (adjusted OR = 13.34; 95% CI: 1.417–125.612; <i>P</i> = 0.024), but bootstrap validation demonstrated instability (BCa 95% CI for β crossed zero), indicating that this finding should be interpreted cautiously. Operative time, surgery type, and anesthetist experience were not significant in the multivariable model.</p> Conclusions <p>Esophageal instrumentation requiring either nasogastric tube or transesophageal echocardiography probe appears associated with increased AD risk, while head/neck positioning showed an association that was unstable in bootstrap validation. Although causal inference is limited by the retrospective design and small event number, clinicians should maintain a high index of suspicion for AD in patients with these risk factors to facilitate early diagnosis and timely intervention.</p>

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Association of nasogastric tube or transesophageal echocardiography probe use and head and neck positioning with arytenoid dislocation after endotracheal intubation: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年7月20日

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  • Wei Qi,
  • Guo-rong Wu,
  • Xu-kai Hu,
  • Jun-ping Chen

摘要

Background

Postoperative hoarseness is a common complaint following endotracheal intubation. Arytenoid dislocation (AD) is a structural injury that, if unrecognized, can lead to prolonged voice impairment. This study aimed to identify independent risk factors for AD using routinely collected perioperative variables.

Methods

This retrospective cohort study included adult patients who underwent general anesthesia with endotracheal intubation at a single institution between January 2022 and December 2024. Patients with documented postoperative hoarseness were included. Demographic, surgical, and anesthetic data were collected. Univariate analysis was followed by multivariable logistic regression to identify independent risk factors for AD. To address potential overfitting due to the limited number of AD events (n = 29), we performed a bootstrap internal validation with 1,000 resamples (bias‑corrected accelerated method).

Results

Among 101,204 intubated patients, 141 had documented postoperative hoarseness, and 87 were included after exclusions. Among patients referred for persistent postoperative hoarseness, AD was confirmed in 29 patients (33.3%), with an overall incidence of 0.03%. Multivariable analysis identified nasogastric tube or transesophageal echocardiography probe use (adjusted OR = 13.68; 95% CI: 2.088–89.619; P = 0.006) as an independent risk factor for AD. A secondary finding was that intraoperative head/neck positioning showed a positive association in the primary analysis (adjusted OR = 13.34; 95% CI: 1.417–125.612; P = 0.024), but bootstrap validation demonstrated instability (BCa 95% CI for β crossed zero), indicating that this finding should be interpreted cautiously. Operative time, surgery type, and anesthetist experience were not significant in the multivariable model.

Conclusions

Esophageal instrumentation requiring either nasogastric tube or transesophageal echocardiography probe appears associated with increased AD risk, while head/neck positioning showed an association that was unstable in bootstrap validation. Although causal inference is limited by the retrospective design and small event number, clinicians should maintain a high index of suspicion for AD in patients with these risk factors to facilitate early diagnosis and timely intervention.