Risk Factors and Assessment Using an Endoscopic Scoring System for Postoperative Respiratory Complications after Anterior Cervical Decompression and Fusion Surgery

Abstract

Introduction: Postoperative respiratory complications (PRC) are one of the most serious complications. Potentially life-threatening accidents can occur after an anterior cervical discectomy and fusion (ADF), such as airway obstruction and aspiration pneumonia. Despite numerous studies, preoperative predictive and preventive methodology has yet to be established. As reported in our previous study, the evaluation of preoperative dysphagia using the eating assessment tool (EAT-10) and a flexible endoscopic evaluation of swallowing (FEES) is useful for predicting the incidence and risk factors of dysphagia after ADF. Methods: This prospective study comprised 60 consecutive patients who underwent ADF. An otolaryngologist and a speech-language-hearing therapist preoperatively and 1 week postoperatively evaluated dysphagia using EAT-10 and Hyodo-Komagane (H-K) scores during FEES. Patient demographics, comorbidities, and pre-and postoperative dysphagia were compared between patients with and without PRC. Results: Seven of 60 (11.6%) patients had preoperative dysphagia diagnosed using the H-K score. A significant positive correlation existed between the pre-and postoperative H-K scores. Of all 60 cases, eight (13.3%) had PRC. Among them, two required reintubation due to airway obstruction and six had aspiration pneumonia. The PRC(+) group was significantly older and more prone to diabetes and asthma. The preoperative H-K score of the PRC(+) group was significantly higher than that of the PRC(−) group. Postoperatively, but not preoperatively, EAT-10 was significantly higher in the PRC(+) group. Conclusions: Preoperative dysphagia may potentially exacerbate postoperative dysphagia after ADF. A preoperative evaluation of dysphagia using the H-K score during FEES is a useful method for predicting and reducing the risk of PRC.

Fiberoptic endoscopic evaluation of swallowing in patients with cervical spinal cord injury: a retrospective study focused on oral intake at discharge

“…Participants in the oral-intake group were younger than those in the parenteral-intake group, and older age was a risk factor for dysphagia. A previous study reported that the preoperative Hyodo score of patients with postoperative respiratory complications was signi cantly higher than that of patients without postoperative respiratory complications [11]. This nding indicates that patients with postoperative respiratory complications tend to have severe preoperative dysphagia.…”

Dysphagia as a Postoperative Complication of Anterior Cervical Discectomy and Fusion

“…Individuals who undergo surgery for cervical spine disease with anterior or posterior access tend to develop oropharyngeal dysphagia, which is often severe during the first month and progressively diminishes in intensity over time [26]. Multivariable analyses have identified smoking status, prior cervical surgery, preoperative C2-C7 angle, preoperative dysphagia, preoperative chronic obstructive pulmonary disease, multilevel surgery, and intraoperative steroid use as significant risk factors for dysphagia after ACDF [26][27][28][29][30]. However, the prospective study by Opsenak et al failed to confirm these findings [31].…”