Factors Associated With Type 1 Thyroplasty Revision: Insights From the TriNetX Database

Objectives: Type 1 thyroplasty (T1T), or medialization laryngoplasty (ML), is a laryngeal framework surgery that corrects glottic insufficiency. Prior studies report revision rates of T1T from 5% to 40%, but factors influencing the need for revision have not been studied in detail. The objectives of this study were to determine the revision rate of T1T and identify patient factors associated with revision. Methods: Retrospective cohort study. Patients undergoing T1T (CPT 31591) were identified in TriNetX, a global collaborative network with data from over 128 million patients. The revision rate was determined by the percentage of patients undergoing a second T1T at least 30 days after the initial procedure. Patient factors (demographics, surgical history, and comorbidities) were compared between groups. Results: A total of 4029 patients underwent T1T; 323 (8.02%) patients underwent revision T1T. Patients undergoing revision were slightly older at initial surgery compared to those not requiring revision (63.5 vs. 61.2 years, p = 0.02), and more likely to be of White or American Native race. Comorbidities associated with revision include pulmonary diseases, neurological conditions, and mental health disorders. A history of thyroidectomy or tracheostomy was also associated with revision. Gender, geographic region, tobacco use, emphysema, Parkinson's disease, and amyotrophic lateral sclerosis were not associated with the need for revision T1T. Conclusion: This is the first comprehensive analysis of factors associated with revision T1T using the TriNetX database. Certain demographic and patient factors may influence the likelihood of requiring revision T1T, potentially impacting patient selection and providing a basis for individualized preoperative patient counseling. Level of Evidence: Level III.