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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Macht M, Wimbish T, Clark BJ, et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care. 2011;15:R231.
Ferraris VA, Ferraris SP, Moritz DM, Welch S. Oropharyngeal dysphagia after cardiac operations. Ann Thorac Surg. 2001;71:1792–5.
Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest. 2010;137:665–73.
Reddy SL, Grayson AD, Griffiths EM, Pulan DM, Rashid A. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac Surg. 2007;84:528–36.
Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 5123 cardiac surgical patients. Eur J Anaesthesiol. 2009;26:396–403.
Barker J, Martino R, Reichardt B, Hickey EJ, Ralph-Edwards A. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery. Can J Surg. 2009;52:119–24.
Hogue CW Jr, Lappas GD, Creswell LL, et al. Swallowing dysfunction after cardiac operations. Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography. J Thorac Cardiovasc Surg. 1995;110:517–22.
Rousou JA, Tighe DA, Garb JL, et al. Risk of dysphagia after transesophageal echocardiography during cardiac operations. Ann Thorac Surg. 2000;69:486–90.
Burgess GE 3rd, Cooper JR Jr, Marino RJ, Peuler MJ, Warriner RA 3rd. Laryngeal competence after tracheal extubation. Anesthesiology. 1979;51:73–7.
Harrington OB, Duckworth JK, Starnes CL, et al. Silent aspiration after coronary artery bypass grafting. Ann Thorac Surg. 1998;65:1599–603.
Partik BL, Scharitzer M, Schueller G, et al. Videofluoroscopy of swallowing abnormalities in 22 symptomatic patients after cardiovascular surgery. AJR Am J Roentgenol. 2003;180:987–92.
Messina AG, Paranicas M, Fiamengo S, et al. Risk of dysphagia after transesophageal echocardiography. Am J Cardiol. 1991;67:313–4.
de Larminat V, Montravers P, Dureuil B, Desmonts JM. Alteration in swallowing reflex after extubation in intensive care unit patients. Crit Care Med. 1995;23:486–90.
Ajemian MS, Nirmul GB, Anderson MT, Zirlen DM, Kwasnik EM. Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management. Arch Surg. 2001;136:434–7.
Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia. 1998;13:208–12.
Tolep K, Getch CL, Criner GJ. Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest. 1996;109:167–72.
Rao V, Ivanov J, Weisel RD, Ikonomidis JS, Christakis GT, David TE. Predictors of low cardiac output syndrome after coronary artery bypass. J Thorac Cardiovasc Surg. 1996;112:38–51.
Bolcal C, Iyem H, Sargin M, et al. Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience. Can J Gastroenterol. 2005;19:613–7.
D’Ancona G, Baillot R, Poirier B, et al. Determinants of gastro-intestinal complications in cardiac surgery. Tex Heart Inst J. 2003;30:280–5.
Postma G, McGuirt WF Sr, Butler SG, Rees CJ, Crandall HL, Tansavatdi K. Laryngopharyngeal abnormalities in hospitalized patients with dysphagia. Laryngoscope. 2007;117:1720–2.
Mencke T, Echternach M, Kleinschmidt S, et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003;98:1049–56.
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.
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.
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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
- Deglutition disorders
- Endotracheal intubation
- Coronary artery bypass grafts
- Heart valve