{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T17:03:40Z","timestamp":1758042220550,"version":"3.44.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:sec id=\"ab-ooi250040-4\"><jats:title>Importance<\/jats:title><jats:p>Thyroplasty and arytenoid adduction are common phonosurgical procedures that generally have low complication rates. However, although rare, airway complications can be life-threatening, and the risk factors remain unclear.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250040-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate the short-term risks of airway obstruction and death within 14 days postoperatively associated with thyroplasty and arytenoid adduction, and to identify modifiable risk factors.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250040-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cohort study used data from the Japanese Diagnosis Procedure Combination database to identify eligible participants from among the patients who underwent thyroplasty or arytenoid adduction from July 2010 to December 2021. Multiple regression and time-dependent Cox regression were used to assess risk factors. Data were analyzed from September 2024 to April 2025.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250040-7\"><jats:title>Exposure<\/jats:title><jats:p>Thyroplasty and arytenoid adduction and potential risk factors, including antiplatelet use, gastroesophageal reflux disease, chronic pulmonary disease, and surgical procedures.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250040-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Tracheostomy, tracheal intubation, or death within 14 days postoperatively.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250040-9\"><jats:title>Results<\/jats:title><jats:p>The analysis included 8626 patients (mean [SD] age, 60.2 [16.2] years; 3127 female [36.3%] and 5499 male [63.7%]), among whom the overall complication rate was 2.03% and the mortality rate, 0.13%. Multivariable analysis showed a clinically meaningful increase in the risk of airway complications associated with advanced age; complexity of the surgical procedure (arytenoid adduction and type III and IV thyroplasty); continuous use of antiplatelets (adjusted relative risk [aRR], 3.49; 95% CI, 1.28-9.54); resumption of antiplatelets (aRR, 2.86; 95% CI, 0.89-9.19) or anticoagulants on postoperative day 1 (aRR, 3.20; 95% CI, 0.77-13.25); presence of chronic obstructive pulmonary disease; and metastatic cancer.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi250040-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>These findings indicate that appropriate management of anticoagulant and antiplatelet therapy, as well as preoperative risk assessment and perioperative airway management for patients with chronic pulmonary disease may help reduce the risk of short-term airway complications after thyroplasty and arytenoid adduction. Individualized risk management in patients undergoing thyroplasty and arytenoid adduction is needed.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2025.2050","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T15:31:07Z","timestamp":1753371067000},"page":"853","source":"Crossref","is-referenced-by-count":0,"title":["Risk Factors for Airway Complications After Thyroplasty and Arytenoid Adduction"],"prefix":"10.1001","volume":"151","author":[{"given":"Keisuke","family":"Kondo","sequence":"first","affiliation":[{"name":"Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan"},{"name":"Department of Otorhinolaryngology, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuhei","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiji","family":"Honda","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Asakage","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Tsutsumi","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyohide","family":"Fushimi","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Shinjo","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","reference":[{"issue":"43","key":"ooi250040r1","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1055\/s-0029-1192223","article-title":"Plastic on the thyroid cartilage to remedy the consequences of unilateral vocal cord paralysis.","volume":"41","author":"Payr","year":"1915","journal-title":"Deutcshe Medizinische Wochenschrift"},{"issue":"5-6","key":"ooi250040r2","doi-asserted-by":"publisher","first-page":"451","DOI":"10.3109\/00016487409126379","article-title":"Thyroplasty as a new phonosurgical technique.","volume":"78","author":"Isshiki","year":"1974","journal-title":"Acta Otolaryngol"},{"issue":"5-6","key":"ooi250040r3","doi-asserted-by":"publisher","first-page":"465","DOI":"10.3109\/00016487509121353","article-title":"Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy.","volume":"80","author":"Isshiki","year":"1975","journal-title":"Acta Otolaryngol"},{"issue":"10","key":"ooi250040r4","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1001\/archotol.1978.00790100009002","article-title":"Arytenoid adduction for unilateral vocal cord paralysis.","volume":"104","author":"Isshiki","year":"1978","journal-title":"Arch Otolaryngol"},{"issue":"5","key":"ooi250040r5","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1007\/s00405-024-08494-3","article-title":"Voice outcome in medialisation thyroplasty with and without arytenoid adduction: a prospective comparison using intraoperative voice measurements.","volume":"281","author":"Mes","year":"2024","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"5_suppl","key":"ooi250040r6","doi-asserted-by":"publisher","first-page":"608S","DOI":"10.1177\/0145561319894414","article-title":"Safety of outpatient type 1 thyroplasty.","volume":"100","author":"Patel","year":"2021","journal-title":"Ear Nose Throat J"},{"issue":"8","key":"ooi250040r7","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.1097\/00005537-200108000-00003","article-title":"Complications of type I thyroplasty and arytenoid adduction.","volume":"111","author":"Abraham","year":"2001","journal-title":"Laryngoscope"},{"issue":"6","key":"ooi250040r8","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/S0194-59989570003-X","article-title":"Laryngeal complications after type 1 thyroplasty.","volume":"113","author":"Cotter","year":"1995","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"ooi250040r9","doi-asserted-by":"publisher","first-page":"NP466","DOI":"10.1177\/01455613211073418","article-title":"Exuberant arytenoid edema following gore-tex thyroplasty.","volume":"103","author":"Adewumi","year":"2024","journal-title":"Ear Nose Throat J"},{"issue":"2","key":"ooi250040r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2022.103769","article-title":"A systematic review and meta-analysis on the outcomes of type I thyroplasty in the irradiated neck.","volume":"44","author":"Entezami","year":"2023","journal-title":"Am J Otolaryngol"},{"issue":"6","key":"ooi250040r11","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1177\/000348949310200602","article-title":"Silastic medialization and arytenoid adduction: the Vanderbilt experience. A review of 116 phonosurgical procedures.","volume":"102","author":"Netterville","year":"1993","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"8","key":"ooi250040r12","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1002\/lary.24622","article-title":"Injection laryngoplasty outcomes in irradiated and nonirradiated unilateral vocal fold paralysis.","volume":"124","author":"Chang","year":"2014","journal-title":"Laryngoscope"},{"issue":"8","key":"ooi250040r13","doi-asserted-by":"publisher","first-page":"1849","DOI":"10.1002\/lary.25770","article-title":"Thyroplasty in the previously irradiated neck: A case series and short-term outcomes.","volume":"126","author":"White","year":"2016","journal-title":"Laryngoscope"},{"issue":"11 Pt 1","key":"ooi250040r14","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1097\/00005537-199811000-00020","article-title":"Complications of phonosurgery: results of a national survey.","volume":"108","author":"Rosen","year":"1998","journal-title":"Laryngoscope"},{"issue":"4","key":"ooi250040r15","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.jvoice.2019.12.015","article-title":"Incidence of and risk factors associated with vocal fold hemorrhage following type i thyroplasty with Gore-tex implant.","volume":"35","author":"Eichorn","year":"2021","journal-title":"J Voice"},{"issue":"4","key":"ooi250040r16","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1177\/0194599815599970","article-title":"Type I thyroplasty in previously irradiated patients: assessing safety and efficacy.","volume":"153","author":"Rosow","year":"2015","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"11","key":"ooi250040r17","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"issue":"6","key":"ooi250040r18","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/j.amjoto.2006.01.017","article-title":"Esophageal regurgitation as a cause of inspiratory distress after thyroplasty.","volume":"27","author":"Yumoto","year":"2006","journal-title":"Am J Otolaryngol"},{"issue":"1","key":"ooi250040r20","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1177\/175114371001100109","article-title":"Antibiotic prophylaxis for percutaneous tracheostomy: A survey of current practice in the UK.","volume":"11","author":"Hanna-Jumma","year":"2010","journal-title":"J Intensive Care Soc"},{"issue":"1","key":"ooi250040r21","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1146\/annurev.publhealth.20.1.145","article-title":"Time-dependent covariates in the Cox proportional-hazards regression model.","volume":"20","author":"Fisher","year":"1999","journal-title":"Annu Rev Public Health"},{"issue":"1","key":"ooi250040r22","article-title":"Comparison of five imputation methods in handling missing data in a continuous frequency table.","volume":"2355","author":"Mohammed","year":"2021","journal-title":"AIP Conf Proc"},{"issue":"5","key":"ooi250040r23","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1002\/lary.31141","article-title":"Safety and adverse events of medialization thyroplasty: a systematic review.","volume":"134","author":"Valley","year":"2024","journal-title":"Laryngoscope"},{"issue":"7","key":"ooi250040r24","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1097\/00005537-200007000-00003","article-title":"Airway compromise in thyroplasty surgery.","volume":"110","author":"Weinman","year":"2000","journal-title":"Laryngoscope"},{"key":"ooi250040r25","doi-asserted-by":"publisher","first-page":"i57","DOI":"10.1093\/bja\/aep271","article-title":"Perioperative considerations for the patient with asthma and bronchospasm.","volume":"103","author":"Woods","year":"2009","journal-title":"Br J Anaesth"},{"issue":"9","key":"ooi250040r26","doi-asserted-by":"publisher","first-page":"574","DOI":"10.4103\/0019-5049.165859","article-title":"Anaesthesia for patient with chronic obstructive pulmonary disease.","volume":"59","author":"Duggappa","year":"2015","journal-title":"Indian J Anaesth"},{"issue":"3","key":"ooi250040r27","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1097\/00000542-199609000-00003","article-title":"Perioperative respiratory complications in patients with asthma.","volume":"85","author":"Warner","year":"1996","journal-title":"Anesthesiology"},{"issue":"3","key":"ooi250040r28","doi-asserted-by":"publisher","first-page":"185","DOI":"10.14639\/0392-100X-817","article-title":"Unravelling the risk factors that underlie laryngeal surgery in elderly.","volume":"36","author":"Crosetti","year":"2016","journal-title":"Acta Otorhinolaryngol Ital"},{"key":"ooi250040r29","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.713965","article-title":"Outcome of elderly patients with surgically treated brain metastases.","volume":"11","author":"Heimann","year":"2021","journal-title":"Front Oncol"},{"issue":"2","key":"ooi250040r30","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s00405-008-0744-3","article-title":"The influence of laryngopharyngeal reflux in the healing of laryngeal trauma.","volume":"266","author":"Kantas","year":"2009","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"11","key":"ooi250040r31","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1288\/00005537-199511000-00015","article-title":"Gastroesophageal reflux prophylaxis decreases the incidence of pharyngocutaneous fistula after total laryngectomy.","volume":"105","author":"Seikaly","year":"1995","journal-title":"Laryngoscope"},{"issue":"2 Pt 1","key":"ooi250040r32","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1097\/00005537-199902000-00023","article-title":"A management strategy for vocal process granulomas.","volume":"109","author":"Havas","year":"1999","journal-title":"Laryngoscope"},{"issue":"11","key":"ooi250040r33","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1097\/00005537-200211000-00003","article-title":"Laryngopharyngeal reflux and laryngeal web formation in patients with pediatric recurrent respiratory papillomas.","volume":"112","author":"Holland","year":"2002","journal-title":"Laryngoscope"},{"key":"ooi250040r34","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1111\/j.1365-2036.2004.02220.x","article-title":"Review article: prevalence and epidemiology of gastro-oesophageal reflux disease in Japan.","volume":"20","author":"Fujimoto","year":"2004","journal-title":"Aliment Pharmacol Ther"},{"issue":"6","key":"ooi250040r35","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1007\/s00535-008-2186-5","article-title":"A randomized, double-blind, placebo-controlled clinical study of the histamine H2-receptor antagonist famotidine in Japanese patients with nonerosive reflux disease.","volume":"43","author":"Hongo","year":"2008","journal-title":"J Gastroenterol"},{"issue":"1","key":"ooi250040r36","doi-asserted-by":"publisher","first-page":"27","DOI":"10.14309\/ajg.0000000000001538","article-title":"ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease.","volume":"117","author":"Katz","year":"2022","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"ooi250040r37","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/s00535-022-01861-z","article-title":"Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021.","volume":"57","author":"Iwakiri","year":"2022","journal-title":"J Gastroenterol"},{"issue":"6","key":"ooi250040r38","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2021.103092","article-title":"Adverse events following injection laryngoplasty: an analysis of the MAUDE database.","volume":"42","author":"Din-Lovinescu","year":"2021","journal-title":"Am J Otolaryngol"},{"key":"ooi250040r19","unstructured":"Japan Laryngological Association. Facility list for type two thyroplasty. May 2024. Accessed October 1, 2024. http:\/\/www.larynx.jp\/topics\/index04.html"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2836844\/jamaotolaryngology_kondo_2025_oi_250040_1756834554.64592.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T15:00:33Z","timestamp":1757602833000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2836844"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2025.2050","relation":{},"ISSN":["2168-6181"],"issn-type":[{"type":"print","value":"2168-6181"}],"subject":[],"published":{"date-parts":[[2025,9,1]]}}}