OBJECTIVES: Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS: For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child–Turcotte–Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS: Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02–0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02–0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient −1.47, 95% CI −2.39 to −0.56) and KPS (coefficient −3.17, 95% CI −5.02 to −1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION: Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.

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Certain patients can achieve functional swallowing goals prior to discharge and avoid the cost and surgical placement of a PEG. This group required an additional 2 to 3 days of hospitalization; however, the usual and customary charges for aggressive dysphagia management in this group were exceeded by charges for PEG placement and in-home therapy according to pricing guidelines for the hospital where these patients were treated. Specific patient profiles of those who were unsuccessful relate to extent of surgery, ie, supraglottic + base of tongue (SUPRA + BOT) and supraglottic + vocal fold (SUPRA + VF) resection, and non-compliance. Complicated patients often require longer rehabilitation and may benefit from a PEG at the time of surgery.

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Purpose/Objective(s): Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) has been associated with improved long-term dysphagia quality of life as compared to chemoradiation. Nevertheless, dysphagia is common in the perioperative period and has been inadequately characterized. Our primary objective in this study is to characterize short-term swallowing outcomes after TORS for OPSCC in a prospective manner in an attempt to improve postoperative outcomes. Materials/Methods: Patients undergoing TORS for OPSCC were prospectively enrolled into this study between the dates of June 20, 2014 and July 31, 2015. Patients were evaluated by a speech-language pathologist postoperatively for diet recommendations and swallow strengthening exercises. The Eating Assessment Tool 10 (EAT-10), a 10-item validated questionnaire measuring swallowing quality of life, was administered on postoperative day (POD) 1, POD 7, and POD 30. A score >3 is considered to be indicative of swallowing dysfunction. Medical records were queried for demographics, clinical history, staging, intraoperative factors, and postoperative course. Patients were excluded for a history of previous TORS or radiation to the oropharynx, repeat TORS within 1 month after enrollment, TORS for nonmalignancy, a procedure on a nonoropharyngeal aerodigestive subsite, a contraindication to swallowing evaluation, or incomplete data. Statistical analysis was performed using a paired t test to compare EAT-10 scores between POD 1 and POD 7 and POD 30. Results: Fifty-nine patients met initial inclusion criteria. Twenty-four patients were excluded (8 for nonoropharyngeal procedures, 5 for contraindications to swallowing evaluation, 7 for repeat TORS within 1 month, and 4 for incomplete data), leaving 35 patients (26 males, 9 females) for analysis. The mean age was 58.8 (range 43-74) years. Four of the 35 patients (11.4%) reported preoperative dysphagia. Twenty of the 35 patients (57.1%) underwent tongue base resection, with the remainder undergoing radical tonsillectomy. T stages were Tx (3), T1 (18), T2 (13), T3 (1), all HPV+. All patients were started on an oral diet by POD 1 without instrumental testing. The mean EAT-10 score (0-40) on POD 1 was 21.5 (range 0-37), on POD 7 was 27.7 (range 14-45), and on POD 30 was 11.9 (range 1-33). EAT-10 scores were significantly worse at POD 7 (PZ.003) and significantly better on POD 30 (P<.001) as compared with initial evaluation. However, at 1 month, only 5 of 34 patients (14.3%) had normal EAT-10 scores. Mean weights (lbs) decreased significantly over the month (207.6 vs 198.8, P<.001). Conclusion: Most patients who undergo TORS experience dysphagia for at least the first month after surgery. Patients can be counseled that dysphagia will worsen by postoperative day 7 and then improve, but it likely will not resolve by 1 month. Swallowing evaluation and therapy should be considered routine in this cohort of patients.