Swallowing dysfunction after cardiac operations: Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography

Abstract

The frequency, importance to patient outcomes, and independent predictors of postoperative swallowing dysfunction documented by barium cineradiography were examined in 869 patients undergoing cardiac operations over a 12-month period. Swallowing dysfunction was diagnosed in 34 patients (4% incidence) and was associated with documented pulmonary aspiration in 90% of these patients, increased frequency of pneumonia (p < 0.0001), need for tracheostomy (p = 0.0002), length of stay in the intensive care unit (p = 0.0001), and duration of hospitalization after the operation (p = 0.0001). Independent predictors of postoperative swallowing dysfunction determined by multivariate logistic regression included age (p < 0.001), length of tracheal intubation after the operation (p = 0.001), and intraoperative use of transesophageal echocardiography (p = 0.003). Dysfunctional swallowing after cardiac operations, a serious complication significantly related to postoperative respiratory morbidity and extended length of hospitalization, is more common in older patients. An association between intraoperative use of transesophageal echocardiography and swallowing dysfunction was also observed in our patients.

Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

“…Penetration of pharyngeal contents into the lower respiratory tract may be facilitated immediately after extubation. 28,29 The inhalation of oropharyngeal flora can cause nosocomial pneumonia, 25,29 and without treatment, lung cavitation and abscess formation may occur. 25,29 Critically ill patients are at high risk for complications during most invasive procedures.…”

Fatores relacionados à disfagia orofaríngea no pós-operatório de cirurgia cardíaca: revisão sistemática

“…The study sample ranged from 254 (18) to 1042 (10) individuals (mean 781.2). Age varied from 65.4±12.1 (18) to 74.3±8.7 (11) years between the groups of patients with dysphagia and from 62.8±11.8 (10) to 63±0.4 (17) years between the groups of patients without dysphasia. The study by Rousou et al (9) did not consider age as a factor for the development of dysphagia between the groups of individuals undergoing TEE.…”

“…Only studies published in English conducted in the United States (60%) (9,10,17) and Canada (40%) (11,18) were included in this literature review. The study sample ranged from 254 (18) to 1042 (10) individuals (mean 781.2).…”

Transesophageal echocardiography-related complications

“…76 Dynamic swallowing studies have proven that four percent of adult patients exhibit mechanical swallowing dysfunction presenting as cough and dysphagia upon extubation after cardiac surgery. 79 Using barium cineradiography, dysphagia was observed in 7.9% of 126 patients undergoing intraoperative TEE during cardiac surgery vs 1.8% of 712 patients who did not undergo TEE. 76 Dysphagia was associated with pulmonary aspiration in 90% of cases, resulting in greater incidence of tracheotomies and a longer hospital stay.…”

“…Associated risk factors include advanced age (P < 0.001), length of postoperative intubation (P < 0.001), and perioperative TEE examination (P < 0.003). 79 In pediatric patients undergoing cardiac surgery, the incidence of dysphagia and left side vocal cord paralysis was 18% and 8%, respectively. 80 Associated risk factors were age of less than three years, tracheal intubation prior to surgery, operation for a left-sided obstructive lesion, and size of the probe in relation to patient's weight.…”