Is Dysphagia After Cardiac Operations a "Preexisting Condition"?

BACKGROUND: Controversy exists about the incidence of dysphagia after cardiac operations, and very little is known about the baseline risk in this patient population. This study evaluated the incidence of dysphagia both preoperatively and postoperatively in patients undergoing cardiac operations.

METHODS: Patients undergoing cardiac operations were screened for dysphagia preoperatively using a 90-mL water swallow challenge protocol, a mini cognitive/speech screen, and a modified oral mechanism screen. The tests were repeated after extubation once the patient was alert and oriented. Patient characteristics were analyzed in conjunction with the results of the swallow screens to identify risk factors for dysphagia.

RESULTS: Of 176 patients tested, 15 (8.5%) failed the swallow screen preoperatively. Age, gender, and comorbidities were compared. Patients who failed the swallow study preoperatively were slightly older (76.1 vs 73.3 years, p = 0.047) and had a higher incidence of chronic renal failure (13.3% v. 0.6%, p = 0.017), but gender and other comorbidities were not significantly different. Postoperatively, 38 patients failed the swallow screen (21.6%). Those who failed the postoperative screen were also older (75.6 vs 72.9 years, p = 0.012), but other factors (including chronic renal failure) were not significantly different. All of the patients who failed the swallow screen preoperatively also failed postoperatively.

CONCLUSIONS: Unrecognized dysphagia in patients who need cardiac operations is a common problem and accounts for a substantial portion of that seen postoperatively. Older patients are at increased risk of dysphagia, but gender and medical comorbidities are not useful predictors of this risk.