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Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection

  • Head and Neck
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Abstract

Purpose

Postoperative laryngeal edema (PLE) is a common complication in patients undergoing head and neck surgery, leading to symptoms such as odynophagia, dysphagia, or potential airway obstruction. However, the prevalence and risk factors of PLE in patients undergoing neck dissection (ND) have not been well investigated.

Methods

A retrospective analysis was conducted in three steps. Initially, a pilot study of 50 consecutive ND patients revealed a preliminary PLE prevalence of 0.34. Then, the medical records of an additional 295 ND patients were reviewed to estimate the prevalence of PLE with a total width of 95% confidence interval (CI) of ± 5%. Finally, multivariable logistic regression analyses were performed to identify risk factors for PLE (n = 343).

Results

PLE occurred in 29.4% [95%CI 24.4–34.4%] of patients undergoing any type of ND, with the most common symptoms of odynophagia (75.0%) and dyspnea (11.1%). Hospital stay was just one day longer in PLE patients, responding well with short-term steroid treatment (p = 0.0057). In multivariable analyses, no significant association was found between PLE occurrence and airway management. However, body mass index and the American Society of Anesthesiologists classification correlated with PLE. More importantly, surgery for oro-hypopharynx or supraglottis tumors (odds ratio, OR = 3.019, [95%CI 1.166–7.815]) and lymph node level 2(3) ND (OR = 4.214 to 5.279, [95%CI 1.160–20.529]) were significant risk factors for PLE.

Conclusions

PLE developed in approximately 30% of ND patients, causing uncomfortable symptoms. Early diagnosis and intervention of PLE in high-risk patients can improve patient care and outcomes.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon request. The data are not publicly available because they contain information that could compromise the privacy of the research participants.

Abbreviations

PLE:

Postoperative laryngeal edema

ND:

Neck dissection

SD:

Standard deviation

IQR:

Interquartile range

ASA:

American Society of Anesthesiologists

RT:

Radiation therapy

OR:

Odds ratio

95% CI:

95% Confidence interval

BMI:

Body mass index

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Funding

This work was supported by grants from No. OTX0001031. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea

    Joo Hyun Park, Kyu Hyeon Hwang, Hee Chun Cho, Junyoung Kim, Subi Oh & Han-Sin Jeong

  2. Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea

    Goeun Park

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  1. Joo Hyun Park
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Correspondence to Han-Sin Jeong.

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The authors declare that they have no conflict of interest in this study.

Ethical approval

The study protocol was approved before data collection (SMC IRB No. 2023-12-015). This study was conducted following the guidelines established by the Declaration of Helsinki. Because there was only minimal risk to subjects in this study, the requirement for written informed consent was waived, and all patient data were de-identified for the analyses.

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Park, J.H., Park, G., Hwang, K.H. et al. Prevalence and risk factors of postoperative laryngeal edema in patients undergoing neck dissection. Eur Arch Otorhinolaryngol (2024). https://doi.org/10.1007/s00405-024-08671-4

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