Incidence of Dysphagia and Associated Morbidity in Lung Transplanted Adults

PURPOSE 1) Determine the incidence of postoperative swallowing impairment in patients undergoing lung transplantation, 2) identify potential demographic or surgical dysphagia risk factors, and 3) examine associated outcomes with aspiration. METHODS A retrospective chart review was conducted in 122 consecutive individuals undergoing lung transplantation (LT) and a routine postoperative modified barium swallowing (MBS) exam. Demographic and health-related outcome data were extracted and MBS films assessed using the validated Penetration Aspiration Scale (PAS) by an expert rater. RESULTS Dysphagia Incidence: 27.3% of LT patients demonstrated safe swallowing (PAS:1-2), 43.8% had laryngeal penetration during swallowing (PAS:3-5), while tracheal aspiration occurred in 28.7% (n=35) of patients (PAS:6-8). Thus, 72.5% (n=87) of LT patients demonstrated unsafe swallowing. Of the aspirators, 51% demonstrated no cough response to tracheal aspirate. RISK FACTORS Body Mass Index (BMI) was significantly lower in aspirators versus non-aspirators (p=0.03) with a negative correlation noted between PAS score and BMI (r=-0.23, p=0.01). A linear by linear association for prevalence of aspiration by weight class was also noted (p=0.04). No relationships were noted for age, race, gender, or operative time with aspiration status (p>0.05). Outcomes Associated with Dysphagia: Compared to non-aspirators, LT patients who aspirated waited 138 hours longer to resume an oral diet (249 vs. 111, p=0.05), spent 192 hours longer in the intensive care unit (359 vs. 167, p<0.04), and an additional 10 days in the hospital (715.6 vs. 473.8, p<0.02). Discharge setting differed by aspiration status (X2=8.7, p=0.03). The odds of being discharged to a non-home setting and needing health-care services were 5.9 and 5.0 times higher, respectively, in LT patients who aspirated, (X2=10.0, p=0.02). CONCLUSION Dysphagia is highly prevalent in LT patients and associated with significant morbidity. These data highlight the need for close monitoring of the LT patient and further suggest a key role for implementation of instrumental assessment techniques for accurate and timely detection of dysphagia.