The Takeaway

This research highlights the importance of identifying and addressing dysphagia before surgery to reduce postoperative risks. Integrating dysphagia screening into preoperative protocols could significantly improve surgical outcomes and patient care.

Key Data:

• 7.9% of patients had dysphagia and/or malnutrition 3 months before surgery
• 3.0% had preoperative dysphagia alone
• 3.8% had preoperative malnutrition alone
• 1.1% had both dysphagia and malnutrition

Impact on outcomes:

• 37% higher odds of 1-year mortality
• 19% higher odds of 90-day readmission
• 35% higher odds of medical/surgical complications

Excerpts

Surgical procedures result in physiologic stress due to accelerated catabolism at a time of increased nutritional needs

In 380,000 adults, they found a ”rate of 7.9 % for dysphagia and/or malnutrition, 3 % for dysphagia alone, 3.8 % for malnutrition alone, and 1.1 % for both conditions

3 months preoperative dysphagia with or without malnutrition is associated with worse postoperative outcomes.

The elevated mortality rates, increased likelihood of readmission, LOS, and heightened occurrence of medical/surgical complications in patients with 3 months preoperative dysphagia with and without malnutrition were independent of not only comorbid disease but also covid and functional status. Furthermore, patients with dysphagia and malnutrition had worse outcomes than patients with dysphagia alone, suggesting patients had more severe dysphagia or worse outcomes due to the compounding negative impact of dysphagia and malnutrition together.

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.

Citation

El Qadir NA, Jones HN, Leiman DA, Porter Starr KN, Cohen SM; National COVID Cohort Collaborative (N3C) Consortium. Preoperative dysphagia and adverse postoperative outcomes in middle aged and older adults. J Clin Anesth. 2024 Nov 28;100:111688. doi: 10.1016/j.jclinane.2024.111688. Epub ahead of print. PMID: 39612865.

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