Factors predicting dysphagia after anterior cervical surgery

Abstract

A multicenter retrospective study.The purpose of this study was to explore risk factors of dysphagia after anterior cervical surgery and factors affecting rehabilitation of dysphagia 2 years after surgery.Patients who underwent anterior cervical surgery at 3 centers from January 2010 to January 2013 were included. The possible factors included 3 aspects: demographic variables—age, sex, body mass index (BMI): hypertension, diabetes, heart disease, smoking, alcohol use, diagnose (cervical spondylotic myelopathy or ossification of posterior longitudinal ligament), preoperative visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), surgical-related variables—surgical option (ACDF, ACCF, ACCDF, or Zero profile), operation time, blood loss, operative level, superior fusion segment, incision length, angle of C2 to C7, height of C2 to C7, cervical circumference, cervical circumference/height of C2 to C7.The results of our study indicated that the rate of dysphagia at 0, 3, 6, 12, and 24 months after surgery was 20%, 5.4%, 2.4%, 1.1%, and 0.4%, respectively. Our results showed that age (58.8 years old), BMI (27.3 kg/m2), course of disease (11.6 months), operation time (103.2 min), blood loss (151.6 mL), incision length (9.1 cm), cervical circumference (46.8 cm), angle of C2 to C7 (15.3°), cervical circumference/height of C2 to C7 (4.8), preoperative VAS (7.5), and ODI (0.6) in dysphagia group were significantly higher than those (52.0, 24.6, 8.6, 88.2, 121.6, 8.6, 42.3, 12.6, 3.7, 5.6, and 0.4, respectively) in nondysphagia group; however, height of C2 to C7 (9.9 vs 11.7 cm) and preoperative JOA (8.3 vs 10.7) had opposite trend between 2 groups. We could also infer that female, smoking, diabetes, ossification of posterior longitudinal ligament, ACCDF, multilevel surgery, and superior fusion segment including C2 to C3 or C6 to C7 were the risk factors for dysphagia after surgery immediately. However, till 2 years after surgery, only 2 risk factors, smoking and diabetes, could slow rehabilitation of dysphagia.Many factors could significantly increase rate of dysphagia after anterior cervical surgery. Operation time as a vital factor markedly increases immediate postoperative dysphagia and smoking, as the most important factor, lower recovery of dysphagia. Further study is needed to prove if these factors could influence dysphagia.

Effects of Body Mass Index on Perioperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery

“…In our study, dysphagia was the most common complication of ACDF with a 3.3% incidence rate and obesity was significantly associated with the development of swallowing difficulties (4.1% vs. 3.22%; OR, 1.121; 95% CI, 1.032–1.218; p = 0.0071). In a retrospective multicenter study of 2,827 ACDFs, Wang et al [ 30 ] also found that patients who developed immediate postoperative dysphagia had a higher BMI than those who did not (27.3 vs. 24.6 kg/m 2 , p ≤ 0.001). Liu et al [ 27 ] reported a similar result during the first to second postoperative days.…”

Anterior Cervical Discectomy and Fusion Complications and Thirty-Day Mortality and Morbidity

“…A predominance in that plate-cage group without clinical significance was noted in that study [11]. Wang et al reported a higher number of dysphagia reaching 20% in the post-operative period [12]. Moreover, Riley et al reported dysphagia rates up to 30% of their population, and it increased with the increase of number of levels instrumented [13].…”

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

“…The comorbidity burden in ACDF procedures has increased over time [ 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.…”

“…In contrast, the data from our report shows dysphagia was less frequent in the global female population, a result comparable to the retrospective analysis by Riley et al [ 24 ] and the NIS database review by Singh et al [ 9 ]. Additionally, previous data suggested age as an independent risk factor for postoperative dysphagia [ 7 , 9 , 15 , 23 , 25 , 26 ]. Our results appear to be congruent with these previous studies, with a 5.9-year age increase seen in the dysphagia group.…”