PHRENIC NERVE IMPAIRMENT SECONDARY TO SURGICAL PROCEDURES: A LITERATURE REVIEW

Introduction: Phrenic nerve impairment is an underrecognized but clinically significant complication of several surgical procedures, particularly cardiothoracic, cervical, and upper abdominal surgeries, and it may lead to diaphragmatic dysfunction with substantial respiratory consequences. Advances in surgical techniques and perioperative care have reduced many complications, yet phrenic nerve injury continues to be reported across multiple specialties, often with delayed diagnosis and heterogeneous clinical presentations. Objective: The main objective of this systematic review was to synthesize the current evidence on phrenic nerve impairment secondary to surgical procedures, with secondary objectives of identifying the most commonly associated surgeries, describing diagnostic approaches, evaluating therapeutic strategies, assessing clinical outcomes, and analyzing the quality and certainty of the available evidence. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP using predefined search terms related to phrenic nerve injury and surgery, with studies selected according to established inclusion and exclusion criteria and synthesized qualitatively. Results and Discussion: A total of 20 studies met the inclusion criteria, encompassing observational studies, case series, and comparative analyses that evaluated phrenic nerve impairment following diverse surgical interventions, most commonly cardiac surgery, thoracic surgery, cervical spine procedures, and regional anesthesia. The evidence highlights variability in incidence, diagnostic timing, and recovery, with ultrasound and electrophysiological studies emerging as key diagnostic tools and both conservative and surgical management strategies being reported. Conclusion: Phrenic nerve impairment remains a relevant postoperative complication with important functional implications, and improved awareness, standardized diagnostic pathways, and evidence-based management strategies are essential to optimize patient outcomes.