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Dysphagia and Associated Risk Factors Following Extubation in Cardiovascular Surgical Patients

Abstract

Following cardiovascular (CV) surgery, prolonged mechanical ventilation of >48 h increases dysphagia frequency over tenfold: 51 % compared to 3–4 % across all durations. Our primary objective was to identify dysphagia frequency following CV surgery with respect to intubation duration. Our secondary objective was to explore characteristics associated with dysphagia across the entire sample. Using a retrospective design, we stratified all consecutive patients who underwent CV surgery in 2009 at our institution into intubation duration groups defined a priori: I (≤12 h), II (>12 to ≤24 h), III (>24 to ≤48 h), and IV (>48 h). Eligible patients were >18 years old who survived extubation following coronary artery bypass alone or cardiac valve surgery. Patients who underwent tracheotomy were excluded. Pre-, peri-, and postoperative patient variables were extracted from a pre-existing database and medical charts by two blinded reviewers. Disagreements were resolved by consensus. Across the entire sample, multivariable logistic regression analysis determined independent predictors of dysphagia. Across the entire sample, dysphagia frequency was 5.6 % (51/909) but varied by group: I, 1 % (7/699); II, 8.2 % (11/134); III, 16.7 % (6/36); and IV, 67.5 % (27/40). Across the entire sample, the independent predictors of dysphagia included intubation duration in 12-h increments (p < 0.001; odds ratio [OR] 1.93, 95 % confidence interval [CI] 1.63–2.29) and age in 10-year increments (p = 0.004; OR 2.12, 95 % CI 1.27–3.52). Patients had a twofold increase in their odds of developing dysphagia for every additional 12 h with endotracheal intubation and for every additional decade in age. These patients should undergo post-extubation swallow assessments to minimize complications.

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Acknowledgments

SAS was supported by an Ontario Graduate Scholarship from the Ontario Ministry of Training, Colleges and Universities. TMY holds the Angelo & Lorenza DeGasperis Chair in Cardiovascular Surgery Research. JI is a staff scientist supported by the Division of Cardiology with the University Health Network and Mount Sinai Hospital. JTG is a physician with the Division of Respirology and Interdepartmental Division of Critical Care with the University Health Network. RM is supported by a Career Award from the Canadian Institutes of Health Research in Aging. SAS, TMY, JI, JTG, and RM had full control of the design of the study, methods, used, outcome parameters and results, analysis of data and production of the written report. We gratefully acknowledge the assistance of: Samir Basmaji for data abstraction and Katie Vikken for data entry.

Conflict of interest

The authors have no conflicts of interest to disclose.

Author information

Correspondence to Stacey A. Skoretz.

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Skoretz, S.A., Yau, T.M., Ivanov, J. et al. Dysphagia and Associated Risk Factors Following Extubation in Cardiovascular Surgical Patients. Dysphagia 29, 647–654 (2014). https://doi.org/10.1007/s00455-014-9555-4

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Keywords

  • Deglutition
  • Deglutition disorders
  • Adult
  • Endotracheal intubation
  • Coronary artery bypass grafts
  • Heart valve
  • Outcomes