The prevalence, risk factors and prognostic implications of dysphagia in elderly patients undergoing hip fracture surgery in Korea

Abstract

BackgroundDysphagia is prevalent in geriatric patients, such as elderly hip fracture patients, and is associated with a poor prognosis. This study investigated (1) the prevalence of dysphagia based on clinical screening and a video-fluoroscopic swallowing study (VFSS), (2) the risk factors of dysphagia, and (3) the prognostic implications of dysphagia in elderly patients (≥ 65 years) undergoing hip fracture surgery.MethodsIn this retrospective study, data from 393 female and 153 male patients ≥65 years of age who underwent surgery for a hip fracture between 2015 and 2018 were analysed. Patients who were considered at high risk of dysphagia after screening underwent a VFSS. To identify risk factors of dysphagia, demographic factors, the American Society of Anesthesiologists classification, past medical history, known risk factors of dysphagia, and factors associated with surgery were analysed using a binary logistic regression model. Odds ratios (ORs) of dysphagia for having poor prognosis including postoperative pneumonia, intensive care unit (ICU) admission, and death within 6 months after surgery were obtained by logistic regression. The association of postoperative pneumonia with poor prognosis was also analysed.ResultsDysphagia was seen in 5.3% of hip fracture patients. In multivariate regression analysis, a serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia (OR [95%CI] = 3.13 [1.40, 7.01]). Dysphagia was identified as a risk factor for postoperative pneumonia in regression analysis after adjustment (OR [95%CI] = 3.12 [1.05, 9.27]). Postoperative pneumonia was significantly associated with ICU admission (OR [95% CI] = 4.56 [1.85, 11.28]) and death within 6 months after surgery (OR [95% CI] = 2.56 [1.03, 6.33]).ConclusionsDysphagia in elderly hip fracture surgery patients was associated with postoperative pneumonia, a risk factor for poor outcomes including ICU admission and death within 6 months after surgery. A serum albumin level < 3.5 g/dL was identified as a risk factor for dysphagia. Therefore, diagnostic testing should be performed to detect dysphagia, especially in patients with a low serum albumin level. Finally, particular care should be taken to prevent postoperative complications in patients with dysphagia.

Association of Sarcopenic Dysphagia with Underlying Sarcopenia Following Hip Fracture Surgery in Older Women

“…In this study, the prevalence of dysphagia after the surgery was 12.3%, which slightly increased to 13.4% at discharge. Previous reports showed the prevalence of dysphagia as 5.3~44% after hip fracture [14][15][16][17]. The difference in the results between those previous studies and ours may be explained by the difference in the diagnosis of dysphagia and the patient characteristics.…”

“…Therefore, it can be inferred that older people with sarcopenia and severely low SMI and hand-grip strength are at higher risk of developing dysphagia after hip fracture surgery. Previous studies indicated that the risk factors for dysphagia in older patients with hip fracture were low serum albumin level, female gender, mental disorientation following surgery, and reduced physical status (ASA III and IV) [14][15][16][17]. Low serum albumin was associated with sarcopenia [13,27].…”

“…The difference in the results between those previous studies and ours may be explained by the difference in the diagnosis of dysphagia and the patient characteristics. For instance, Byun et al assessed the dysphagia using video fluorography and reported its prevalence as 5.3% [17], which may also have been an underestimate because the evaluation was conducted only in patients with possible dysphagia (7.3%). Meals et al conducted a study on patients undergoing therapies by speech and language pathologists and reported a 42% prevalence of dysphagia [14]; moreover, the survey was conducted in a population suspected of clinical dysphagia, which expectedly reported a higher prevalence of dysphagia.…”

“…Cases of sarcopenia were reported in 17~58% of older patients with hip fractures [11][12][13]. Furthermore, dysphagia was reported to occur in 5.3~44% of patients who underwent operative treatment for hip fractures [14][15][16][17]. Dysphagia in older patients with hip fracture was associated with risk factors such as low serum albumin levels, female gender, confusion after surgery, and preoperative worsening of physical status [14][15][16][17].…”

“…Furthermore, dysphagia was reported to occur in 5.3~44% of patients who underwent operative treatment for hip fractures [14][15][16][17]. Dysphagia in older patients with hip fracture was associated with risk factors such as low serum albumin levels, female gender, confusion after surgery, and preoperative worsening of physical status [14][15][16][17]. In particular, no study has yet explored the association between sarcopenia and dysphagia following hip fracture.…”