Risk Factors for Intubation-Related Laryngeal Granulomas: A Prospective Study in Surgical Patients.

Abstract

Introduction: This study aimed to determine the frequency of intubation-related laryngeal granulomas (ILGs) after surgery under general anesthesia and identify risk factors, with a focus on tube type and duration.

Methods: A single-center prospective cohort (November 2012-September 2013) of adults undergoing elective surgery expected to last at least 5 h with intubation was conducted. Fiberoptic laryngoscopy was performed on the day after extubation and at 1 week, 1 month, and 3 months. Candidate variables included tube type (single lumen vs. double lumen [DLT]), intubation duration, Cormack-Lehane grade, intraoperative transesophageal echocardiography (TEE), gastroesophageal reflux disease, body mass index, sex, and age. Associations were evaluated using univariate tests and multivariable logistic regression.

Results: Forty patients were analyzed (median age, 73 years; 19 men). Cardiovascular surgery accounted for 25 of 40 cases (62.5%); DLTs were used in 6 of 40 (15.0%) and TEE in 22 of 40 (55.0%). Mucosal changes (erythema/white plaque) were observed on day 1 in 18 of 40 patients (45.0%). ILG was detected at 1 week in 10 of 40 patients (25.0%), including nine after cardiovascular surgery. Eight of 10 cases (80%) resolved spontaneously by 1 month, whereas 2 of 10 (20%) enlarged and required 2 months of inhaled steroid therapy, with complete resolution by 3 months. Univariate analysis revealed that both intubation duration ≥13 h (p = 0.014) and DLT use (p = 0.026) were significantly associated with ILG. In multivariable analysis, intubation duration ≥13 h (adjusted odds ratio [aOR]: 10.697, 95% confidence interval [CI]: 1.639-69.828; p = 0.013) and DLT use (aOR: 14.521, 95% CI: 1.531-137.680; p = 0.020) were independent risk factors.

Conclusion: In this cohort, ILG was detected in 25% of patients at 1 week post-extubation and typically resolved within 1 month. Prolonged intubation and DLT use were independently associated with increased ILG risk. High-risk patients - particularly those with prolonged intubation or DLT exposure - may benefit from selection of the smallest appropriate DLT when required and targeted laryngoscopy within 1 month. These findings should be interpreted cautiously, given the small sample and single-center design.

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