Outcomes of Aspiration Prevention Surgery: A Retrospective Cohort Study Using a Japanese Claims Database

Mizuno, Kayoko; Takeuchi, Masato; Kanazawa, Yuji; Kishimoto, Yo; Suehiro, Atsushi; Iwanaga, Ken; Kawakami, Koji; Omori, Koichi

doi:10.1007/s00455-022-10416-6

Cited by 4 publications

(6 citation statements)

References 25 publications

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“…APSs are performed to change the pharyngolaryngeal structure for aspiration prevention [3][4][5][6][7][8]. There are several types of APSs, such as removal of the larynx, altering the structure of the trachea, and closure of the larynx (Table 1 and Fig.…”

Section: Aspiration Prevention Surgeriesmentioning

confidence: 99%

“…Several reports have shown that APSs prevent aspiration and increase oral intake in 50%-80% of patients [24,36,49,53,82]. It is particularly effective for patients with higher levels of consciousness and mobility and those aged ≤ 30 years [7,29]. The postoperative oral intake status can improve after an APS, but the influence of the disease background of the patients should be considered.…”

Section: Clinical Outcomes and Benefitsmentioning

confidence: 99%

“…Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and to date, various aspiration prevention surgeries (APSs) have been introduced [3][4][5][6][7][8], but only a few review articles have summarized APSs since 2010.…”

Section: Introductionmentioning

confidence: 99%

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Aspiration prevention surgeries: a review

et al. 2023

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Background Severe dysphagia can cause intractable pneumonia and lead to life-threatening conditions. Intractable aspiration can occur despite medical management for aspiration prevention. Surgical intervention is indicated for intractable aspiration to prevent potentially life-threatening complications. Since the 1970s, several surgical treatments to prevent aspiration have been reported, and various aspiration prevention surgeries have been introduced, but little is known about them or their benefits. This is a review of the types of aspiration prevention surgery, with the aim of increasing aspiration prevention surgery awareness and their clinical outcomes among medical professionals, which will guide the choices of aspiration prevention surgeries for patients with intractable aspiration. Main body Aspiration prevention surgeries can be categorized into three according to their approaches: removal of the larynx, altering the structure of the trachea, and closure of the larynx. Aspiration prevention surgeries to remove the larynx include total and central-part laryngectomy. Aspiration prevention surgeries to alter the structure of the trachea include tracheoesophageal diversion, laryngotracheal separation, and the tracheal flap method. Surgeries to close the larynx can be divided into supraglottic laryngeal closure, glottic laryngeal closure, and subglottic laryngeal closure. Aspiration prevention surgeries prevent aspiration and increase oral intake in 50–80% of patients. Most patients lose vocal function after aspiration prevention surgeries; however, some patients who have undergone total laryngectomy or laryngotracheal separation restored their speech function through tracheoesophageal puncture and use of voice prosthesis. Postoperative suture failure is frequent after epiglottic flap closure and total laryngectomy but rare after central-part laryngectomy, laryngotracheal separation, glottic closure, and subglottic closure. Furthermore, aspiration prevention surgeries improve the quality of life of patients and their caregivers by decreasing suctioning frequency. Conclusions In this review, we described the history and development of aspiration prevention surgeries. Medical professionals need to continually improve their knowledge and skills to facilitate appropriate aspiration prevention surgeries according to patient condition.

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Section: Aspiration Prevention Surgeriesmentioning

confidence: 99%

Section: Clinical Outcomes and Benefitsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aspiration prevention surgeries: a review

et al. 2023

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“…After excluding head and neck cancer patients, all but one patient included in the analysis had a neurological diagnosis. Following surgery, the number of pneumonia episodes decreased by 53.6%, or 1.5 episodes less per year as compared to prior to surgery 155 …”

Section: Surgical Airway Separationmentioning

confidence: 92%

“…Following surgery, the number of pneumonia episodes decreased by 53.6%, or 1.5 episodes less per year as compared to prior to surgery. 155…”

Section: Invasive Ventilationmentioning

confidence: 99%

Respiratory considerations in patients with neuromuscular disorders

2023

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Patients with neuromuscular disorders (NMDs) develop respiratory impairment as muscles weaken. Ensuing complications include reductions in lung volume, compliance, and cough ability and increased risk for lung infections. Sleep disordered breathing results from weakened upper airway muscles and/or impaired central ventilatory control systems. Evaluation includes measurement of seated and supine vital capacity (VC) and respiratory muscle strength. Assisted cough techniques facilitate airway clearance. The decision to initiate assisted ventilation is multifactorial, and may include consideration of patient symptoms, spirometry, pulmonary pressures, sleep studies or blood gas values. Most patients prefer noninvasive ventilation to enhance mobility and independence. Tracheostomy is indicated when bulbar function is impaired and cough assist measures fail to clear the airway. Technological advances in respiratory support have improved quality of life and longevity. Home care is the best option for most patients but remains a challenge, especially for caregivers with regard to physical, emotional, and financial implications, as well as social, administrative, and insurance concerns.

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Management and Treatment for Dysphagia in Neurodegenerative Disorders

Ueha,

Cotaoco,

Kondo

et al. 2023

JCM

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Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or in the entire process. This review outlines the approach to dysphagia in the setting of NDDs. Distinguishing the etiology of dysphagia can be difficult, and it is important to always look out for signs pointing to NDD as the cause. Thorough diagnostic work-up is essential, and it includes a comprehensive history and physical examination, alongside swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, and high-resolution manometry. Management requires a multidisciplinary approach with a treatment plan tailored to each patient. This involves dietary guidance, swallowing rehabilitation, and surgery in cases in which improvement with rehabilitation is inadequate. Surgery may involve altering certain pharyngolaryngeal structures to facilitate swallowing and reduce the risk of aspiration (swallowing improvement surgery) or separating the airway and digestive tract while sacrificing laryngeal function, with the main goal of preventing aspiration (aspiration prevention surgery). Proper management stems from recognizing the impact of these disorders on swallowing and consistently finding ways to improve the quality of life of patients.

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Outcomes of Aspiration Prevention Surgery: A Retrospective Cohort Study Using a Japanese Claims Database

Cited by 4 publications

References 25 publications

Aspiration prevention surgeries: a review

Aspiration prevention surgeries: a review

Respiratory considerations in patients with neuromuscular disorders

Management and Treatment for Dysphagia in Neurodegenerative Disorders

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