1
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Chen W, Tian L, Pan W. Effect of topical steroid on soft tissue swelling following anterior cervical discectomy and fusion. J Family Med Prim Care 2024; 13:1020-1023. [PMID: 38736809 PMCID: PMC11086796 DOI: 10.4103/jfmpc.jfmpc_1396_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/15/2023] [Accepted: 11/13/2023] [Indexed: 05/14/2024] Open
Abstract
Background Anterior cervical discectomy and fusion is the most commonly used surgical approach for treating cervical spine conditions, but it can often lead to postoperative swallowing difficulties. To retrospectively assess the effects of topical triamcinolone acetonide in the anterior cervical surgery on swallowing function. Methods In this study, a retrospective design was used to select patients aged 18 years and older who were diagnosed with cervical spondylosis and required anterior cervical discectomy and fusion. Among them, the patients in the experimental group used triamcinolone acetonide topically in front of the plate during surgery, and the control group was the patients who did not use triamcinolone acetonide. The sex, age, operation time, operation segment, and preoperative soft tissue area were compared between the two groups. Results There were no significant differences in gender, age, operation time, and segment between the two groups. For the preoperative soft tissue area, triamcinolone acetonide was significantly lower than in the control group (P < 0.05). Conclusion The retrospective results of this study support that topical triamcinolone acetonide as a treatment in anterior cervical surgery can significantly reduce soft tissue swelling, and no effect was found on the operation time, postoperative blood loss, and segment. These findings provide an important basis for clinical care teams to make treatment decisions and confirm the effectiveness of triamcinolone acetonide in improving swallowing function. However, there was a possibility of information collection and selection bias due to the limitations of retrospective studies. To confirm and further advance the use of this treatment, more rigorous prospective randomized controlled trials are recommended to validate these preliminary results.
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Affiliation(s)
- Weifu Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Long Tian
- Department of Orthopedics, Langzhong People’s Hospital, Langzhong, Sichuan, China
| | - Wenjun Pan
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
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2
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Sharaf OM, Hao KA, Demos DS, Plowman EK, Ahmed MM, Jeng EI. Utility of Fiberoptic Endoscopic Evaluation of Swallowing After Left Ventricular Assist Device Implantation. Cureus 2023; 15:e42291. [PMID: 37609102 PMCID: PMC10441160 DOI: 10.7759/cureus.42291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Dysphagia following cardiac surgery is common and associated with adverse outcomes. Among patients receiving left ventricular assist devices (LVAD), we evaluated the impact of fiberoptic endoscopic evaluation of swallowing (FEES) on outcomes. Methods A single-center pilot study was conducted in adults (≥18 years of age) undergoing durable LVAD (February 2019 - January 2020). Six patients were prospectively enrolled, evaluated, and underwent FEES within 72 hours of extubation-they were compared to 12 control patients. Demographic, surgical, and postoperative outcomes were collected. Unpaired two-sided t-tests and Fisher's exact tests were performed. Results Baseline characteristics were similar between groups. Intraoperative criteria including duration of transesophageal echo (314 ± 86 min) and surgery (301 ± 74 min) did not differ. The mean time of intubation was comparable (57.3 vs. 68.7 hours, p=0.77). In the entire cohort, 30-day, one-year, two-year, and three-year mortality were 0%, 5.6%, 5.6%, and 16.7%, respectively. Sixty-seven percent of the patients that underwent FEES had inefficient swallowing function. The FEES group trended to a shorter hospital length of stay (LOS) (29.1 vs. 46.6 days, p=0.098), post-implantation LOS (25.3 vs 30.7 days, p=0.46), and lower incidence of postoperative pneumonia (16.7% vs. 50%, p=0.32) and sepsis (0% vs. 33.3%, p=0.25). Conclusion FEES did not impact 30-day, one-year, two-year, or three-year mortality. Though not statistically significant, patients who underwent FEES trended toward shorter LOS and lower postoperative pneumonia and sepsis rates. Additionally, we report a higher incidence of dysphagia among patients undergoing FEES despite comparable baseline risk factors with controls.
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Affiliation(s)
- Omar M Sharaf
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Kevin A Hao
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Daniel S Demos
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Emily K Plowman
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida Health, Gainesville, USA
| | - Eric I Jeng
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, USA
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3
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Tetreault L, Lange SF, Chotai S, Lupo M, Kryshtalskyj MT, Wilson JR, Martin AR, Davies BM, Nater A, Devin C, Fehlings MG. A Systematic Review of Definitions for Dysphagia and Dysphonia in Patients Treated Surgically for Degenerative Cervical Myelopathy. Global Spine J 2022; 12:1535-1545. [PMID: 34409882 PMCID: PMC9393984 DOI: 10.1177/21925682211035714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort with swallowing (dysphagia) as well as changes in sound production (dysphonia). This systematic review aims to (1) outline how dysphagia and dysphonia are defined in the literature and (2) assess the quality of definitions using a novel 4-point rating system. METHODS An electronic database search was conducted for studies that reported on dysphagia, dysphonia or other related complications of DCM surgery. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A 4-point rating scale was developed to assess the quality of definitions for each complication. RESULTS Our search yielded 2,673 unique citations, 11 of which met eligibility criteria and were summarized in this review. Defined complications included odynophagia (n = 1), dysphagia (n = 11), dysphonia (n = 2), perioperative swelling complications (n = 2), and soft tissue swelling (n = 3). Rates of dysphagia varied substantially (0.0%-50.0%) depending on whether this complication was patient-reported (4.4%); patient-reported using a modified Swallowing Quality of Life questionnaire (43.1%) or the Bazaz criteria (8.8%-50.0%); or diagnosed using an extensive protocol consisting of clinical assessment, a bedside swallowing test, evaluation by a speech and language pathologist and a modified barium swallowing test/fiberoptic endoscopy (42.9%). The reported incidences of dysphonia also ranged significantly from 0.6% to 38.0%. CONCLUSION There is substantial variability in reported rates of dysphagia and dysphonia due to differences in data collection methods, diagnostic strategies, and definitions. Consolidation of nomenclature will improve evaluation of the overall safety of surgery.
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Affiliation(s)
- Lindsay Tetreault
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University College Cork, Graduate Entry Medicine, Cork, Ireland
| | - Stefan F. Lange
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Groningen, Groningen, the Netherlands
| | - Silky Chotai
- Department of Orthopaedics and Neurological Surgery, Spine Outcomes Research Laboratory, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mercedes Lupo
- University College Cork, Graduate Entry Medicine, Cork, Ireland
| | - Michael T. Kryshtalskyj
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jefferson R. Wilson
- Department of Neurosurgery, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Allan R. Martin
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin M. Davies
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Anick Nater
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Clinton Devin
- Department of Orthopaedics and Neurological Surgery, Spine Outcomes Research Laboratory, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael G. Fehlings
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Center, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,Department of Surgery, University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Department of Surgery, University of Toronto; Division of Neurosurgery and Spinal Program, Toronto Western Hospital, University Health Network, 399 Bathurst St., Suite 4W-449, Toronto, Ontario, Canada M5T 2S8.
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4
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Ju MH, Kim JB. “Dysphagia” the Most Common But Most Undervalued Complication. JACC: ASIA 2022; 2:114-115. [PMID: 36340255 PMCID: PMC9627813 DOI: 10.1016/j.jacasi.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Finnegan BS, Meighan MM, Warren NC, Hatfield MK, Alexeeff S, Lipiz J, Nguyen-Huynh M. Validation Study of Kaiser Permanente Bedside Dysphagia Screening Tool in Acute Stroke Patients. Perm J 2021; 24:1. [PMID: 33482958 DOI: 10.7812/tpp/19.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Dysphagia occurs in up to 50% of patients with acute stroke symptoms, resulting in increased aspiration pneumonia rates and mortality. The purpose of this study was to validate a health system's dysphagia (swallow) screening tool used since 2007 on all patients with suspected stroke symptoms. Annual rates of aspiration pneumonia for ischemic stroke patients have ranged from 2% to 3% since 2007. METHODS From August 17, 2015 through September 30, 2015, a bedside dysphagia screening was prospectively performed by 2 nurses who were blinded to all patients age 18 years or older admitted through the emergency department with suspected stroke symptoms at 21 Joint Commission accredited primary stroke centers in an integrated health system. The tool consists of 3 parts: pertinent history, focused physical examination, and progressive testing from ice chips to 90 mL of water. A speech language pathologist blinded to the nurse's screening results performed a formal swallow evaluation on the same patient. RESULTS The end study population was 379 patients. Interrater reliability between 2 nurses of the dysphagia screening was excellent at 93.7% agreement (Ƙ = 0.83). When the dysphagia screenings were compared with the gold standard speech language pathologist professional swallow evaluation, the tool demonstrated both high sensitivity (86.4%; 95% confidence interval = 73.3-93.6) and high negative predictive value (93.8%; 95% confidence interval = 87.2-97.1). CONCLUSION This tool is highly reliable and valid. The dysphagia screening tool requires minimal training and is easily administered in a timely manner.
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Affiliation(s)
| | - Melissa M Meighan
- Kaiser Permanente Northern California Regional Licensing, Quality and Accreditation, Oakland, CA
| | - Noelani C Warren
- Kaiser Permanente Southern California, Moreno Valley Medical Center, Moreno Valley, CA
| | - Meghan K Hatfield
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Stacey Alexeeff
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Jorge Lipiz
- Kaiser Permanente Southern California, Riverside Medical Center, Riverside, CA
| | - Mai Nguyen-Huynh
- Kaiser Permanente Northern California Division of Research, Oakland, CA.,Kaiser Permanente Northern California, Diablo Service Area, Walnut Creek, CA
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McIntyre M, Chimunda T, Koppa M, Dalton N, Reinders H, Doeltgen S. Risk Factors for Postextubation Dysphagia: A Systematic Review and Meta-analysis. Laryngoscope 2020; 132:364-374. [PMID: 33320371 DOI: 10.1002/lary.29311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify, describe, and where possible meaningfully synthesize the reported risk factors for postextubation dysphagia (PED) in critically ill patients. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic search of peer-reviewed and grey literature was conducted in common scientific databases to identify previously evaluated risk factors of PED. Data extraction and risk of bias assessment used a double-blind approach. Random effects models were used for the meta-analyses. Meta-analyses were conducted where sufficient study numbers allowed after accounting for statistical and clinical heterogeneity. RESULTS Twenty-five studies were included, which investigated a total of 150 potential risk factors. Of these, 63 risk factors were previously identified by at least one study each as significantly increasing the risk of PED. After accounting for clinical and statistical heterogeneity, only two risk factors were suitable for meta-analysis, gender, and duration of intubation. In separate meta-analyses, neither gender (RR 1.00 [0.71, 1.43], I2 = 0%) nor duration of intubation (RR 1.54 [-0.40, 3.49], I2 = 0%) were significant predictors of PED. CONCLUSIONS A large number of risk factors for PED have been reported in the literature. However, significant variability in swallowing assessment methods, patient populations, timing of assessment, and duration of intubation prevented meaningful meta-analyses for the majority of these risk factors. Where meta-analysis was possible, gender and duration of intubation were not identified as risk factors for PED. We discuss future directions in clinical and research contexts. Laryngoscope, 2020.
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Affiliation(s)
- Melanie McIntyre
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Department of Speech Pathology, Bendigo Health, Bendigo, Victoria, Australia
| | - Timothy Chimunda
- Division of Critical Care, Bendigo Health, Bendigo, Victoria, Australia.,Department of Intensive Care Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia.,Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Mayank Koppa
- School of Rural Health, Monash University, Melbourne, Victoria, Australia
| | - Nathan Dalton
- School of Rural Health, Monash University, Melbourne, Victoria, Australia
| | - Hannah Reinders
- Department of Speech Pathology, Bendigo Health, Bendigo, Victoria, Australia
| | - Sebastian Doeltgen
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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7
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McIntyre M, Doeltgen S, Dalton N, Koppa M, Chimunda T. Post-extubation dysphagia incidence in critically ill patients: A systematic review and meta-analysis. Aust Crit Care 2020; 34:67-75. [PMID: 32739246 DOI: 10.1016/j.aucc.2020.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Post-extubation dysphagia has been associated with adverse health outcomes. To assist service planning and process development for early identification, an understanding of the number of patients affected is required. However, significant variation exists in the reported incidence which ranges from 3% to 62%. OBJECTIVES The objective of this study was to (i) conduct a meta-analysis on the incidence of dysphagia after endotracheal intubation in adult critically ill patients and (ii) describe the extent of heterogeneity within peer-reviewed articles and grey literature on the incidence of dysphagia after endotracheal intubation. DATA SOURCES Databases CINAHL, Cochrane Library, Embase, MEDLINE, PubMed, SpeechBITE, and Google Scholar were systematically searched for studies published before October 2019. REVIEW METHODS Data extraction occurred in a double-blind manner for studies meeting the inclusion criteria. Risk of bias was determined using critical appraisal tools relevant to the individual study design. The overall quality of the synthesised results was described using the Grading of Recommendations Assessment, Development and Evaluation methodology. Raw data were transformed using Freeman-Tukey arcsine square root methodology. A random-effects model was utilised owing to heterogeneity between studies. RESULTS Of 3564 identified studies, 38 met the criteria for inclusion in the final review. A total of 5798 patient events were analysed, with 1957 dysphagic episodes identified. The combined weighted incidence of post-extubation dysphagia was 41% (95% confidence interval, 0.33-0.50). Of the patients with dysphagia, 36% aspirated silently (n = 155, 95% confidence interval, 0.22-0.50). Subgroup meta-regression analysis was unable to explain the heterogeneity across studies when accounting for the method of participant recruitment, method of dysphagia assessment, median duration of intubation, timing of dysphagia assessment, or patient population. CONCLUSION Dysphagia after endotracheal intubation is common and occurs in 41% of critically ill adults. Given the prevalence of dysphagia and high rates of silent aspiration in this population, further prospective research should focus on systematic and sensitive early identification methods.
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Affiliation(s)
- Melanie McIntyre
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia; Bendigo Health, Department of Speech Pathology, GPO Box 126, Bendigo, Victoria, 3552, Australia.
| | - Sebastian Doeltgen
- Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Nathan Dalton
- Monash University School of Rural Health, PO Box 666, Bendigo, Victoria, 3552, Australia
| | - Mayank Koppa
- Monash University School of Rural Health, PO Box 666, Bendigo, Victoria, 3552, Australia
| | - Timothy Chimunda
- Bendigo Health, Department of Intensive Care Medicine, GPO Box 126, Bendigo, Victoria, 3552, Australia; University of Queensland, St Lucia, Queensland, 4072, Australia; University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
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8
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Taft TH, Kern E, Starkey K, Craft J, Craven M, Doerfler B, Keefer L, Kahrilas P, Pandolfino J. The dysphagia stress test for rapid assessment of swallowing difficulties in esophageal conditions. Neurogastroenterol Motil 2019; 31:e13512. [PMID: 30474165 PMCID: PMC6386586 DOI: 10.1111/nmo.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Esophageal dysphagia is a common symptom in gastroenterology practice. Current rapid assessment tools are limited to oropharyngeal dysphagia and do not translate well to esophageal conditions. We aim to create a novel tool, the dysphagia stress test (DST), to evaluate swallowing in patients with esophageal disease characterized by dysphagia. METHODS Adults with eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), achalasia, and dysphagia not otherwise specified (NOS) participated. Patient controls with non-esophageal diagnoses and healthy controls were also recruited. Participants completed the DST with five bolus challenges: water, applesauce, rice, bread, barium tablet and rated their swallowing difficulty and pain. A study clinician observed and documented water use and refusal of any challenges. Participants also completed measures of esophageal symptoms, hypersensitivity, and symptom anxiety to evaluate the DST validity. Collinearity of bolus challenges guided item reduction. KEY RESULTS A total of 132 subjects participated. Both control groups and GERD patients had the best swallowing ability, while achalasia, EOE, and dysphagia NOS scored poorer. About 90% of patients were able to attempt or pass each of the bolus challenges, suggesting high acceptability. Construct validity of the DST is evidenced by modest negative correlations with symptom severity, hypersensitivity, and anxiety. The DST does not appear to be influenced by brain-gut processes. Applesauce, rice, and bread demonstrated collinearity; thus, the DST was reduced to three challenges. CONCLUSIONS & INFERENCES The DST is the first rapid assessment tool designed for gastroenterology clinics with direct observation of swallowing ability across several conditions to mitigate issues related to patient self-report of esophageal symptoms.
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Affiliation(s)
- Tiffany H Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Emily Kern
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Kristen Starkey
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Jenna Craft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Meredith Craven
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Bethany Doerfler
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Laurie Keefer
- Icahn School of Medicine, Mount Sinai Medical Center, Susan and Leonard Feinstein IBD Center
| | - Peter Kahrilas
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - John Pandolfino
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
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9
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Mukdad L, Toppen W, Nguyen S, Kim K, Mendelsohn AH, Zarrinpar A, Benharash P. A Targeted Swallow Screen for the Detection of Postoperative Dysphagia in Liver Transplant Patients. Prog Transplant 2018; 29:4-10. [DOI: 10.1177/1526924818817035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. We have demonstrated the validity of a bedside targeted swallow evaluation following cardiac surgery. Since dysphagia following liver transplantation is not well examined, we evaluated the efficacy of this swallow screen method in postoperative liver transplant patients. Methods: This was a prospective trial involving adult patients who underwent liver transplant surgery at our institution over a 5-month period. Within 24 hours of extubation and prior to the initiation of oral intake, all patients were evaluated using the targeted swallow screen, which is a direct assessment of mental status and laryngeal sensation/elevation upon swallowing of progressively larger amounts of water. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. Results: During the study, 50 patients were screened. Twenty (40%) failed the targeted swallow screen, while 18 (90%)/20 failed the subsequent fiberoptic endoscopic examination (overall dysphagia incidence = 40%). Patients with dysphagia were older and had significantly longer intensive care unit and hospital stays. The screening test had a 90% sensitivity and a specificity of 83% for detecting dysphagia. Conclusion: The true incidence of dysphagia following liver transplantation appears to be significantly higher than previously recognized. A simple bedside swallow screen can efficiently screen these patients for dysphagia. Our findings require further validation and may support programs for reduction and early detection of dysphagia.
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Affiliation(s)
- Laith Mukdad
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William Toppen
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Son Nguyen
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kwang Kim
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ali Zarrinpar
- Department of Transplantation Surgery, University of Florida Health, Gainesville, FL, USA
| | - Peyman Benharash
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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10
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Jenkins TJ, Nair R, Bhatt S, Rosenthal BD, Savage JW, Hsu WK, Patel AA. The Effect of Local Versus Intravenous Corticosteroids on the Likelihood of Dysphagia and Dysphonia Following Anterior Cervical Discectomy and Fusion: A Single-Blinded, Prospective, Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1461-1472. [PMID: 30180054 DOI: 10.2106/jbjs.17.01540] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dysphagia and dysphonia are the most common postoperative complications following anterior cervical discectomy and fusion (ACDF). Although most postoperative dysphagia is mild and transient, severe dysphagia can have profound effects on overall patient health and on surgical outcomes. The purpose of this study was to compare the efficacy of local to intravenous (IV) steroid administration during ACDF on postoperative dysphagia and dysphonia. METHODS This was a single-blinded, prospective, randomized clinical trial. Seventy-five patients undergoing ACDF with cervical plating were randomized into 3 groups: control (no steroid), IV steroid (10 mg of IV dexamethasone at the time of closure), or local steroid (40 mg of local triamcinolone). Patient-reported outcome measures (PROMs) were collected for dysphagia, dysphonia, and neck pain postoperatively for 1 year. RESULTS Patient demographics were similar. Postoperative day 1 PROMs showed significantly lower scores for dysphonia (p = 0.015) and neck pain (p = 0.034) in the local steroid group. At 2 weeks postoperatively, the local steroid cohort showed significantly decreased prevalence of severe dysphagia (Eating Assessment Tool-10 [EAT-10], severe dysphagia, p = 0.027) compared with the control and IV steroid groups. Both steroid groups had significantly less severe dysphagia when compared with the control group at the 6-week and 3-month time points. At 1 year postoperatively, both steroid groups had significantly reduced dysphagia rates (p = 0.014) compared with the control group. CONCLUSIONS Both local and IV steroid administration after cervical plating in ACDF yielded better PROMs for dysphagia compared with a control group. This finding is particularly evident in the reduced number of patients who reported severe dysphagia symptoms following ACDF with local steroid application within the first 2 postoperative weeks. Future studies should attempt to stratify dysphagia severity when reporting outcomes related to anterior cervical spine surgery. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tyler James Jenkins
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Rueben Nair
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Surabhi Bhatt
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brett David Rosenthal
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jason W Savage
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alpesh A Patel
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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11
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Nagoshi N, Tetreault L, Nakashima H, Arnold PM, Barbagallo G, Kopjar B, Fehlings MG. Risk Factors for and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery for Degenerative Cervical Myelopathy: Results from the AOSpine International and North America Studies. J Bone Joint Surg Am 2017; 99:1069-1077. [PMID: 28678119 DOI: 10.2106/jbjs.16.00325] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although dysphagia is a common complication after anterior cervical decompression and fusion, important risk factors have not been rigorously evaluated. Furthermore, the impact of dysphagia on neurological and quality-of-life outcomes is not fully understood. The aim of this study was to determine the prevalence of and risk factors for dysphagia, and the impact of this complication on short and long-term clinical outcomes, in patients treated with anterior cervical decompression and fusion. METHODS Four hundred and seventy patients undergoing a 1-stage anterior or 2-stage anteroposterior cervical decompression and fusion were enrolled in the prospective AOSpine CSM (Cervical Spondylotic Myelopathy) North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of perioperative dysphagia. Preoperatively and at each follow-up visit, patients were evaluated using the modified Japanese Orthopaedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short Form-36 Health Survey (SF-36). A 2-way repeated-measures analysis of covariance was used to evaluate differences in outcomes at 6 and 24 months between patients with and those without dysphagia, while controlling for relevant baseline characteristics and surgical factors. RESULTS The overall prevalence of dysphagia was 6.2%. Bivariate analysis showed the major risk factors for perioperative dysphagia to be a higher comorbidity score, older age, a cardiovascular or endocrine disorder, a lower SF-36 Physical Component Summary score, 2-stage surgery, and a greater number of decompressed levels. Multivariable analysis showed patients to be at an increased risk of perioperative dysphagia if they had an endocrine disorder, a greater number of decompressed segments, or 2-stage surgery. Both short and long-term improvements in functional, disability, and quality-of-life scores were comparable between patients with and those without dysphagia. CONCLUSIONS The most important predictors of dysphagia are an endocrine disorder, a greater number of decompressed levels, and 2-stage surgery. At the time of both short and long-term follow-up, patients with perioperative dysphagia exhibited improvements in functional, disability, and quality-of life scores that were similar to those of patients without dysphagia. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Narihito Nagoshi
- 1Division of Neurosurgery and Spinal Program, Department of Surgery (N.N., L.T., H.N., and M.G.F.), and Institute of Medical Science (L.T. and M.G.F.), Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 2Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan 3Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan 4University of Kansas, Kansas City, Kansas 5Department of Neurosurgery, University Hospital Catania, Catania, Italy 6Department of Health Services, University of Washington, Seattle, Washington
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Nguyen S, Zhu A, Toppen W, Ashfaq A, Davis J, Shemin R, Mendelsohn AH, Benharash P. Dysphagia after Cardiac Operations is Associated with Increased Length of Stay and Costs. Am Surg 2016; 82:890-893. [DOI: 10.1177/000313481608201006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the true incidence of postoperative dysphagia after cardiac surgery is unknown, it has been reported to occur in 3 to 21.6 per cent of patients. Historically, dysphagia has been associated with increased surgical complications and prolonged hospital stay. This study aimed to evaluate the costs and outcomes associated with dysphagia after cardiac surgery. Patients undergoing nonemergent, nontransplant cardiac operations between June 2013 and June 2014 were eligible for inclusion. Independent predictors of cost were identified through a multivariate linear regression model. Of the 354 patients (35% female) included for analysis, 56 (16%) were diagnosed with postoperative dysphagia. On univariate analysis, patients with dysphagia had increased intensive care unit and total hospital lengths of stay (11.8 vs 5.2 days, P < 0.001 and 18.2 vs 9.7 days, P < 0.001, respectively), and a 57 ± 15 per cent increase in cost of care ( P < 0.001). Dysphagia was not associated with higher rates of in-hospital mortality (3.6% vs 3.0%, P = 0.83). On multivariate linear regression, the development of dysphagia was independently associated with a 45.1 per cent increase in total hospital costs [95% confidence interval (31% and 59%), P < 0.001]. Dysphagia is an independent and major contributor to health care costs after cardiac operations, suggesting that postoperative dysphagia represents a highly suitable target for quality improvement and cost containment efforts.
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Affiliation(s)
- Son Nguyen
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Allen Zhu
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - William Toppen
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Adeel Ashfaq
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Jessica Davis
- UCLA Division of Cardiac Surgery, Los Angeles, California and
| | - Richard Shemin
- UCLA Division of Cardiac Surgery, Los Angeles, California and
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