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J Thorac Cardiovasc Surg 1995;110:517-522
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

SWALLOWING DYSFUNCTION AFTER CARDIAC OPERATIONS: Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography

St. Louis, Mo.

From the Divisions of Cardiothoracic Anesthesia and Surgery, Department of Radiology, Washington University School of Medicine, and Department of Speech Pathology, Barnes Hospital, St. Louis, Mo.

Received for publication Oct. 27, 1994. Accepted for publication Jan. 20, 1995. Address for reprints: Charles W. Hogue, Jr., MD, Division of Cardiothoracic Anesthesia, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8054, St. Louis, MO 63105

Abstract

The frequency, importance to patient outcomes, and independent predictors of postoperative swallowing dysfunction documented by barium cineradiography were examined in 869 patients undergoing cardiac operations over a 12-month period. Swallowing dysfunction was diagnosed in 34 patients (4% incidence) and was associated with documented pulmonary aspiration in 90% of these patients, increased frequency of pneumonia (p < 0.0001), need for tracheostomy (p = 0.0002), length of stay in the intensive care unit (p = 0.0001), and duration of hospitalization after the operation (p = 0.0001). Independent predictors of postoperative swallowing dysfunction determined by multivariate logistic regression included age (p < 0.001), length of tracheal intubation after the operation (p = 0.001), and intraoperative use of transesophageal echocardiography (p = 0.003). Dysfunctional swallowing after cardiac operations, a serious complication significantly related to postoperative respiratory morbidity and extended length of hospitalization, is more common in older patients. An association between intraoperative use of transesophageal echocardiography and swallowing dysfunction was also observed in our patients. (J THORACCARDIOVASCSURG1995;110:517-22)

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