Effectiveness of intraoperative nerve monitoring in reducing rates of recurrent laryngeal nerve injury in aerodigestive and cardiovascular pediatric surgery
Topic overview
Retrospective study of 426 pediatric procedures shows intraoperative nerve monitoring reduces vocal fold impairment by 44% compared to no monitoring (11.4% vs 20.2%). Protection is even stronger in children with pre-existing vocal fold issues (68.6% risk reduction), with bilateral paralysis 14× less likely when monitoring is used.
Key takeaways
- Intraoperative nerve monitoring reduced vocal fold impairment by 44% in pediatric aerodigestive/cardiovascular surgery (11.4% vs 20.2%, NNT=12)
- Children with pre-existing vocal fold impairment benefit most from monitoring (69% risk reduction, NNT=3)
- Bilateral vocal fold impairment was 14× more likely without monitoring (5.6% vs 0.3%)
- Increasing IONM use correlated with decreasing injury rates year-over-year across 426 procedures
- IONM should be standard for cervicothoracic/cardiothoracic cases, especially with baseline vocal fold dysfunction
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