Dysphagia Following Cardiac Surgery: Prevalence, Risk Factors and Associated Outcomes

Abstract: Objectives Determine the prevalence of swallowing impairment in adults following cardiac surgery and examine associated risk factors and health-related outcomes. Methods A prospective single center study was conducted in postoperative adult cardiac surgery patients with no history of dysphagia. A standardized fiberoptic endoscopic evaluation of swallowing was performed within 72 hours of extubation. Blinded raters completed validated outcomes of swallowing safety and efficiency. Demographic, surgical and postoperative health-related outcomes were collected. Univariate and multivariable regression analyses were performed with odds ratios (OR) and 95% confidence intervals (CI). Results In 182 patients examined, imaging confirmed inefficient swallowing (residue) in 52% of patients and unsafe swallowing in 94% (65% penetrators, 29% aspirators). Silent aspiration was observed in 53% of aspirators and a further 32% did not clear aspirate material. Independent risk factors for aspiration included: NYHA III-IV (OR:2.9, CI:1.2 to 7.0); reoperation (OR:2.0, CI:0.7 to 5.5); transesophageal echocardiogram images > 110 (OR:2.6, CI:1.1 to 6.3); intubation > 27 hours (OR:2.1, CI:0.8 to 5.3); and endotracheal tube size ≥ 8.0 (OR:3.1, CI:1.1 to 8.6). Patients with three or four identified risk factors had a 16.4 (CI:3.2 to 148.4) and 22.4 (CI:3.7 to 244.7) increased odds of aspiration, respectively. Compared to non-aspirators, aspirators waited an additional 85-hours to resume oral intake, incurred $49,372 increased costs, and experienced a 43% longer hospital stay, p Conclusions Tracheal aspiration was prevalent, covert, and associated with increased morbidity and mortality.