Preoperative dysphagia and adverse postoperative outcomes in middle aged and older adults

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-28 DOI:10.1016/j.jclinane.2024.111688

Narmeen Abd El Qadir , Harrison N. Jones , David A. Leiman , Kathryn N. Porter Starr , Seth M. Cohen , National COVID Cohort Collaborative (N3C) Consortium

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引用次数: 0

Abstract

Background

Dysphagia is a swallowing impairment with adverse health consequences. The impact of preoperative dysphagia on postoperative outcomes is not known. This study will examine the association between preoperative dysphagia and postoperative outcomes.

Methods

This is a retrospective, observational study of patients ≥50 years of age undergoing surgery not directly involving the swallowing mechanism (i.e., oral cavity, larynx, pharynx, or esophagus). The National COVID Cohort Collaborative (N3C) database from January 1st, 2020 to August 31st, 2023 was used. The N3C database comprises electronic health record (EHR) data from more than 75 US health systems and harmonizes these data in a centralized resource. The main predictor was dysphagia with or without malnutrition in the 3 months prior to surgery. Logistic regression models assessed the association between our main predictor and outcomes of mortality, readmission, and medical/surgical complications adjusted for covariates. A negative binomial regression model was used for length of stay (LOS).

Results

380,869 adults ≥50 years old were included, mean age 66.0 (SD = 9.2), 52.6 % male. 7.9 % had dysphagia and/or malnutrition 3 months preoperatively including 3.0 % preoperative dysphagia alone, 3.8 % preoperative malnutrition alone, and 1.1 % both. Adjusted models demonstrated higher odds of mortality (1-year mortality odds ratio (OR) 1.37, 95 % confidence interval (CI) 1.29 to 1.44), readmission (90-day readmission OR 1.19, 95 % CI 1.14 to 1.24), and medical/surgical complications (OR 1.35, 95 % CI 1.28 to 1.42) among patients with 3 months preoperative dysphagia with or without malnutrition compared to patients with neither condition.

Conclusion

Patients with 3 months preoperative dysphagia with and without malnutrition had poor postoperative outcomes. These findings highlight the rationale for integrating dysphagia screening and intervention into routine preoperative protocols to mitigate the risk of adverse postoperative outcomes.

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中老年人术前吞咽困难与术后不良后果

背景吞咽困难是一种吞咽障碍，会对健康造成不良影响。术前吞咽困难对术后结果的影响尚不清楚。本研究将探讨术前吞咽困难与术后结果之间的关联。方法这是一项回顾性观察研究，研究对象是年龄≥50 岁、接受非直接涉及吞咽机制（即口腔、喉、咽或食道）手术的患者。使用的是 2020 年 1 月 1 日至 2023 年 8 月 31 日的国家 COVID 队列协作（N3C）数据库。N3C 数据库包括来自超过 75 个美国医疗系统的电子健康记录 (EHR) 数据，并将这些数据统一到一个集中的资源中。主要预测因素是手术前3个月内有无营养不良的吞咽困难。逻辑回归模型评估了主要预测因子与死亡率、再入院率和内外科并发症等结果之间的关系，并对协变量进行了调整。结果 380,869 名年龄≥50 岁的成年人被纳入其中，平均年龄为 66.0 岁（SD = 9.2），52.6% 为男性。术前 3 个月出现吞咽困难和/或营养不良的比例为 7.9%，其中术前单独出现吞咽困难的比例为 3.0%，术前单独出现营养不良的比例为 3.8%，同时出现吞咽困难和/或营养不良的比例为 1.1%。调整后的模型显示，患者的死亡率（1 年死亡率几率比 (OR) 1.37，95% 置信区间 (CI) 1.29 至 1.44）、再入院率（90 天再入院率 OR 1.19，95% CI 1.14 至 1.24）和内科/外科并发症（OR 1.35，95% CI 1.结论术前3个月吞咽困难伴或不伴营养不良的患者术后效果不佳。这些发现强调了将吞咽困难筛查和干预纳入常规术前方案以降低术后不良预后风险的合理性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.