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Incidence and Predictors of Dysphagia Following Anterior Cervical Discectomy and Fusion

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed operations on the spine. While complication rates are relatively low, ACDF can be associated with specific risks, including dysphagia, leading to aspiration risk, dietary modification, and even nasogastric feeds or gastrostomy in the severest of cases. However, the incidence of dysphagia following ACDF reported in the literature varies due to differences in measures and time intervals applied, ranging from nearly 3/4 at 2 weeks to 13% at 12 months. And the most commonly used dysphagia scales remain subjective, non-validated, and do not capture functional impact. Various risk factors have been identified though few consistently reproduced and none studied in an Australasian context.

The aims of this study were to use objective and validated measures, assess both traditional and novel risk factors, and determine the impact of dysphagia on dietary status, length of stay and complications. Twenty-nine adults undergoing ACDF for degenerative pathologies were enrolled between March and November 2015 in an Australian institution. Bazaz dysphagia scale, Dysphagia short questionnaire, 3-ounce swallow test and dietary status were assessed preoperatively and 2 days and 6 weeks postoperatively. Descriptive statistics were used to characterize the study sample and logistic regression modeling performed on risk factors.

Dysphagia incidence ranged from 85% on day-2 Dysphagia short questionnaire to zero on 6-week 3-ounce swallow. All measures increased at 2 days and fell by 6 weeks. Failing day-2 3-ounce swallow was the only measure associated with modifications in solids (P = 0.06), showing significant linear correlation (P = 0.02). Respiratory comorbidity increased risk of failing day-2 3-ounce swallow by more than 32-fold (OR: 32.4; 95% CI: 1.8 - 587.7; P = 0.019) and scoring moderate or severe on Bazaz by almost 10-times (OR: 9.3; 95% CI: 0.9 - 95.95; P = 0.061). Psychiatric history also increased risk of failing day-2 3-ounce swallow by more than 10-fold (OR: 10.9; 95% CI: 1 - 123.7; P = 0.054). Failing 3-ounce swallow increased length of stay (5 versus 7 days; P = 0.013).

In conclusion, dysphagia incidence and severity are highest during the immediate postoperative period, and dysphagia improves in the majority of cases by 6 weeks, and varies according to the measure used, with the 3-ounce swallow test most predictive of dietary modification and length of stay, independent of postoperative complication. Respiratory comorbidity poses the most significant dysphagia risk, followed by psychiatric history.

Article by Yingda Li, et al, from Australia.

Full access: http://mrw.so/20L2ou
Image by Myositis Support, from Flickr-cc.

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