Oral Posters: Values and Outcomes in Spine Surgery

Presented by: D. Bullard - View Audio/Video Presentation (Members Only)

Author(s):

D. Bullard(1), S. Evans(1), A. Seaman(1)

(1) Triangle Neurosurgery, Raleigh, NC, United States

Abstract

Introduction: A common complication of ACDF surgery is dysphagia, an abnormality in the ability to control a phase of the swallowing process. Dysphagia is reported to occur in 2-60% of patients, depending on how and when it is measured. A lack of conclusive evidence in the literature leaves the etiology of postoperative dysphagia unclear. Among those patients who experience dysphagia, there is a subset whose dysphagia lasts more than 6 months. There is also evidence to suggest that for some patients the onset of dysphagia is delayed, presenting 1-4 months post-operatively. This study presents a novel understanding of dysphagia as a progressive postoperative complication rather than a binary condition, and attempts to discern risk factors that would help to identify high-risk patients, especially for prolonged and delayed-onset dysphagia, so that special preventative measures can be taken.

Methods: The current study is a retrospective chart review of 732 patients who underwent ACDF surgery at a private neurosurgery practice over the course of 7 years. All patients who consented to enrollment were included. Surgeries were performed by one surgeon using standard preventative techniques including release of endotracheal cuff pressure during retraction, use of steroids, use of minimal retraction, and no use of esophageal catheters. Data were segregated between those with and without dysphagia at 1, 3, 6, and 12 months. The demographic and surgical statistics of each group at each time-point were then compared via t-test to assess any significant differences. Demographic statistics included gender, BMI, age, nicotine use, GERD, heart disease, hypertension, diabetes, and osteoporosis. Surgical statistics included operation duration, number of surgical levels, and revision status. Short-form dysphagia protocol was used to determine the presence of dysphagia.

Results: Incidence of revision in dysphagia patients differed significantly from those without dysphagia at 1 and 12 months. At 3 months, incidence of diabetes was higher in dysphagia patients. Heart disease and osteoporosis incidence correlated with higher rates of dysphagia at 6 months. Age differed significantly at 6 and 12 months, and operative duration among dysphagia patients differed significantly at all time-points. Our analysis revealed no significant differences between those with delayed-onset dysphagia and the general patient population.

Conclusion: These results affirm the effects that several factors have been reported to have on dysphagia. They also implicate specific factors as associated with dysphagia acquisition and others with its long-term retention. Acquisition appears to be associated with revision status, diabetes, and operative duration, while retention was associated with age, operation duration, heart disease, osteoporosis, and revision status. This study's evaluation of long-term dysphagia constitutes a novel understanding of dysphagia as a progressive postoperative complication with differing factors affecting acquisition vs. retention, and sheds light on its mechanisms in a diverse patient population. While there were no demographic or surgical factors linked to delayed-onset dysphagia, significant evidence for considering the condition as distinct from general or chronic dysphagia exists. More data and further analysis will be required to elucidate the factors associated with this type of dysphagia and the mechanistic differences particular to dysphagia types.