Risk factors for postoperative swallowing dysfunction in elderly patients undergoing gastrointestinal cancer surgery: A retrospective cohort study.

PURPOSES: Postoperative swallowing dysfunction is a complication that adversely affects elderly patients undergoing gastrointestinal cancer surgery. However, the perioperative changes in swallowing function and their predictive factors remain unclear.

METHODS

The subjects of this retrospective analysis were 170 patients aged ≥ 65 years who underwent gastrointestinal cancer surgery and screened positively for sarcopenia and/or cognitive or swallowing concerns. Swallowing function was assessed using the Fujishima Eating and Swallowing Ability Grade (Fujishima Grade), a 10-point scale commonly used in Japan, at four perioperative time points. Dysfunction was defined as Grade ≤ 7 on postoperative day (POD) 1. Predictors were identified using univariate and multivariate logistic regression.

RESULTS

Swallowing dysfunction developed in 63 patients (37.1%). The median grade declined on POD1 and improved by POD7 and on discharge. Among those with dysfunction, 21.0% remained at grade 7 on discharge. These patients had significantly lower cognitive scores (p < 0.001). Multivariate analysis identified age ≥ 75 years (OR 2.56, p = 0.034), sarcopenia (OR 2.13, p = 0.048), MMSE (Mini-Mental State Examination) ≤ 23 (OR 3.09, p = 0.007), and preoperative Fujishima Grade 8 (OR 2.48, p = 0.011) as independent predictors.

CONCLUSIONS

Swallowing function declines transiently after gastrointestinal cancer surgery in elderly patients. Older age, sarcopenia, MMSE ≤ 23, and preoperative Fujishima Grade 8 are independent predictors of postoperative swallowing dysfunction.