Correlation of antithrombotic medication use with lower incidence of postoperative dysphagia following anterior cervical spine surgery.

OBJECTIVE

Previous studies have identified decreased esophageal blood flow during anterior cervical surgery as a contributing factor to postoperative dysphagia. However, the effects of antithrombotic agents on esophageal blood flow during recovery from surgery have yet to be explored. This study examines the relationship between antithrombotic medication use and postoperative dysphagia in patients undergoing anterior cervical spine procedures.

METHODS

A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical spine surgery were categorized based on preoperative antithrombotic drug usage and propensity score matched by age, race, sex, and other baseline characteristics. Dysphagia rates were compared between groups using Eating Assessment Tool-10 questionnaires. Univariate analyses were used to examine the effects of antithrombotic medications on the rates of postoperative dysphagia.

RESULTS

Of 1661 patients meeting inclusion criteria, 629 (37.9%) reported taking antithrombotic agents preoperatively. Propensity score matching yielded 784 patients, with 392 (50%) who took prescription antithrombotic medications. Patients taking antithrombotic agents experienced significantly lower rates of postoperative dysphagia at 1 (48% vs 58%, p = 0.049), 3 (21% vs 28%, p = 0.033), and 12 (19% vs 26%, p = 0.048) months after surgery compared with those who did not. After separating the cohorts by surgical approach, patients taking antithrombotic medications who underwent anterior cervical surgery experienced significantly lower rates of dysphagia at 3 months (21% vs 30%, p = 0.019) but not at 1 month (51% vs 59%, p = 0.2) or 12 months (19% vs 26%, p = 0.058) postoperatively, while rates for patients undergoing a posterior approach were similar regardless of antithrombotic drug use.

CONCLUSIONS

Patients taking antithrombotic medications experience significantly lower rates of dysphagia after anterior cervical surgery. Antithrombotic drugs may enhance microcirculation within the esophagus postoperatively, protecting against the detrimental effects of prolonged esophageal retraction during anterior cervical surgery that have been found to contribute to postoperative dysphagia. This novel finding warrants further investigation.