Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion

Joseph, Jacob R.; Smith, Brandon W.; Mummaneni, Praveen V.; Marca, Frank La; Park, Paul

doi:10.1016/j.jocn.2016.03.011

Cited by 17 publications

(19 citation statements)

References 24 publications

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“…1 The following comorbidities were identified as independent risk factors for the development of dysphagia by our study and many others: smoking, 26,27 fluid and electrolyte disorders, 9,16 paralysis, 9,16 coagulopathy, neurodegenerative diseases, 9 alcohol abuse, 9,16 diabetes with chronic complications, 28 depression and psychosis. 9,16,28 In contrast to some studies regarding obesity, 6,27,29 our results showed that body mass index was significantly associated with dysphagia. Similarly, Wang et al 26 and Liu et al 30 found increased rates in the immediate postoperative period only.…”

Section: Patient Related Risk Factorssupporting

confidence: 57%

“…The incidence of dysphagia after ACDF in this study was 3.3%, which appears to be consistent with several other large database studies. 9,15,16 However, the reported incidence in the literature varies widely due to a lack of unifying criteria and variations in study design. 7 In a systematic review of mainly prospective cohort studies, Riley et al 8 reported dysphagia rates ranging from 1%-79% within the first week (mean, 33%), decreasing to 13%-21% (mean, 16.8%) 1 year after surgery.…”

Section: Discussionmentioning

confidence: 99%

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National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

et al. 2021

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Anterior cervical discectomy and fusion (ACDF) is the most common performed surgery in the cervical spine. Dysphagia is one of the most frequent complications following ACDF. Several studies have identified certain demographic and perioperative risk factors associated with increased dysphagia rates, but few have reported recent trends. Our study aims to report current trends and factors associated with the development of inpatient postoperative dysphagia after ACDF. Methods: The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were selected. Time trend series plots were created for the yearly treatment trends for each fusion level by dysphagia outcome. Separate univariable followed by multivariable logistic regression analyses were performed to evaluate predictors of dysphagia. Results: A total of 1,212,475 ACDFs were identified in which 3.3% experienced postoperative dysphagia. A significant increase in annual dysphagia rates was observed from 2004-2014. Frailty, intraoperative neuromonitoring, 4 or more level fusions, African American race, fluid/electrolyte disorders, blood loss, and coagulopathy were all identified as significant independent risk factors for the development of postoperative dysphagia following ACDF. Conclusion:Postoperative dysphagia is a well-known postsurgical complication associated with ACDF. Our cohort showed a significant increase in the annual dysphagia rates independent of levels fused. We identified several risk factors associated with the development of postoperative dysphagia after ACDF.

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Section: Patient Related Risk Factorssupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

et al. 2021

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“…While complication rates are relatively low, ACDF can be associated with specific risks, including dysphagia, leading to aspiration risk, dietary modification, and even nasogastric feeds or gastrostomy in the severest of cases. Furthermore, postoperative dysphagia has been associated with increased length of stay (LOS), readmission rate, in-hospital costs and mortality [1]. Dysphagia incidence reported in the literature varies widely due to differences in measurement tools used and time intervals applied, with rates of up to 71% at 2 weeks [2], gradually decreasing but persistent in up to 13% at 12 months [3].…”

Section: Incidencementioning

confidence: 99%

Incidence and Predictors of Dysphagia Following Anterior Cervical Discectomy and Fusion: Prospective Observational Study

Li¹,

Hitos²,

Mon³

et al. 2018

OJMN

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The incidence of dysphagia following anterior cervical discectomy and fusion (ACDF) reported in the literature varies due to differences in measures and time intervals applied, ranging from nearly 3/4 at 2 weeks to 13% at 12 months. The most commonly used dysphagia scales remain subjective, nonvalidated, and do not capture functional impact. Various risk factors have been identified, though few consistently reproduced and none studied in an Australasian context. The aims of this study were to use objective and validated measures, assess both traditional and novel risk factors, and determine the impact of dysphagia on dietary status, length of stay and complications. METHODS: Twenty-nine adults undergoing ACDF for degenerative pathologies were enrolled between March and November 2015 in an Australian institution. Bazaz dysphagia scale, Dysphagia short questionnaire, 3-ounce swallow test and dietary status were assessed preoperatively, and 2 days and 6 weeks postoperatively. Descriptive statistics were used to characterise the study sample and logistic regression modelling performed on risk factors. RESULTS: Dysphagia incidence ranged from 85% on day-2 Dysphagia short questionnaire to zero on 6-week 3-ounce swallow. All measures increased at 2 days and fell by 6 weeks. Failing day-2 3-ounce swallow was the only measure associated with modifications in solids (P = 0.06), showing significant linear correlation (P = 0.02). Respiratory comorbidity increased risk of failing day-2 3-ounce swallow by more than 32-fold (OR: 32.4; 95% CI: 1.8 -587.7; P = 0.019) and scoring moderate or severe on Bazaz by almost 10-times (OR: 9.3; 95% CI: 0.9 -95.95; P = 0.061). Psychiatric history also increased risk of failing day-2 3-ounce swallow by more than 10-fold (OR: 10.9; 95% CI: 1 -123.7; P = 0.054). Failing 3-ounce swallow increased length of stay (5 versus 7 days; How to cite this paper:

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“…1 has become a common degenerative disease in clinical, which may severely affect quality of life or even lead to disability in elderly population. [1,2] As we known, anterior surgery, not only providing su cient decompression but also improving cervical lordosis, are widely used in treatment for cervical diseases such as multilevel Cervical Disorder with Kyphosis [1][2][3]. However, it is di cult to avoid some related complications like dysphagia with greater effect on patients' quality of life and psychological, varying from 1-79% morbidity reported in previous studies [4,5].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Dysphagia after Anterior Surgery in Treatment for Multilevel Cervical Disorder with Kyphosis

Wei

Chen

et al. 2021

Preprint

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Study Design: A retrospective study.Objective: The purpose of this study was to clarify the risk factors associated with dysphagia following anterior surgery treating multilevel cervical disorder with kyphosis based on subgroup of follow-up time.Methods: Totally, 81 patients who suffered from multilevel cervical disorder with kyphosis receiving anterior surgery from July 2018 to June 2020 were reviewed for clinical and radiological outcomes. Patients with dysphagia was defined as dysphagia group and without dysphagia as no-dysphagia group according to follow-up time (1 week, 1-month, 3-month, 6-month and 1-year after surgery). Data was performed to compare between the patients with and without dysphagia.Results: In our study, the occurrence of dysphagia was 67.9%, 44.4%, 34.6%，25.9% and 14.8% at the time of 1 week, 1-month, 3-month, 6-month, and 1 -year after surgery, respectively. Our findings showed that a history of smoking, lower preoperative Swallowing Quality of Life (SWAL-QOL) score, post-operative Cobb angle of C2-7 and change of Cobb angle of C2-7 were associated with dysphagia within 3-month after surgery. Furthermore, a history of smoking, lower preoperative SWAL-QOL score, and post-operative Cobb angle of C2-7 were linked with dysphagia within 6-month after surgery. However, a history of smoking and lower preoperative SWAL-QOL score were found to be risk factors related with dysphagia at at any follow-up.Conclusions: In the present study, many factors were related with dysphagia during 3-month after surgery. What’s more, a history of smoking and lower preoperative SWAL-QOL score were associated with dysphagia at any follow-up. We hope this article can provide a reference for spinal surgeons to predict which patients were susceptible to suffer from dysphagia after anterior surgery in treatment of multilevel cervical disorder with kyphosis.

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Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion

Cited by 17 publications

References 24 publications

National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

Incidence and Predictors of Dysphagia Following Anterior Cervical Discectomy and Fusion: Prospective Observational Study

Risk Factors Associated with Dysphagia after Anterior Surgery in Treatment for Multilevel Cervical Disorder with Kyphosis

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