Postoperative Hoarseness After General Anesthesia Referred for Otolaryngological Consultation: A 10-Year Retrospective Study

Abstract

BACKGROUND: Patients referred to otolaryngologists due to postoperative hoarseness often require further treatment, prolonging hospitalization and impairing their quality of life; however, this uncommon complication remains understudied. We retrospectively examined the data from patients referred to our Otolaryngology Department to determine its incidence, associated factors, and prognosis. METHODS: At our hospital, 676,641 patients underwent general anesthesia between October 2015 and September 2025. Of these, 1185 were referred to the Otolaryngology Department with postoperative laryngopharyngeal complaints, 958 of whom were diagnosed with hoarseness. Postoperative hoarseness referred for otolaryngological consultation was the primary outcome of our study. We determined its incidence and used multivariable logistic regression to identify factors distinguishing hoarseness from other referred complaints. Secondary outcomes included hoarseness-related vocal fold injury identified during consultation and patient prognosis. The former was analyzed using ordinal logistic regression to determine associated factors. For the latter, recovery trajectories among patients with postoperative hoarseness were compared using Kaplan–Meier curves and log-rank tests, and associated factors were identified using Cox regression. An expanded-cohort sensitivity analysis (n = 1438; 480 controls) assessed the primary finding’s robustness. RESULTS: The incidence of postoperative hoarseness referred for otolaryngological consultation was 958/676,641 (0.142%). Within the referral cohort, nasogastric tube placement (odds ratio [OR] = 2.34, 95% confidence interval [CI], 1.63–3.38, P < .001) and transesophageal echocardiography (TEE) (OR = 1.84, 95% CI, 1.15–3.02, P = .014) were independently associated with hoarseness versus other laryngopharyngeal complaints. In this cohort, greater vocal fold injury severity was associated with nasogastric tube placement (OR = 2.11, 95% CI, 1.61–2.78, P < .001), TEE (OR = 1.61, 95% CI, 1.15–2.25, P = .006), longer surgical duration (OR = 1.10/h, 95% CI, 1.03–1.18, P = .003), double-lumen tube (OR = 1.55, 95% CI, 1.04–2.31, P = .033), and female sex (OR = 1.41, 95% CI, 1.11–1.80, P = .005). Among referred patients with hoarseness, delayed first consultation (≥6 days after symptom onset) and greater vocal fold injury severity were associated with slower recovery (both P < .001). The primary association between nasogastric tube placement and hoarseness persisted in the expanded-cohort sensitivity analysis (OR = 4.20, 95% CI, 3.00–5.95, P < .001). CONCLUSIONS: The incidence of postoperative hoarseness referred for otolaryngological consultation was ~1.5/1000. Within the referral cohort, nasogastric tube placement was most strongly associated with hoarseness versus other laryngopharyngeal complaints and, together with TEE, longer surgical duration, double-lumen tube insertion, and female sex, was associated with greater vocal fold injury severity.