Impact of Frailty on Postoperative Dysphagia in Patients Undergoing Elective Cardiovascular Surgery

Masato Ogawa; Seimi Satomi-Kobayashi; Naofumi Yoshida; Kodai Komaki; Kazuhiro P Izawa; Mari Hamaguchi; Takeshi Inoue; Yoshitada Sakai; Ken-Ichi Hirata; Kenji Okada

doi:10.1016/j.jacasi.2021.10.011

Impact of Frailty on Postoperative Dysphagia in Patients Undergoing Elective Cardiovascular Surgery

JACC Asia. 2022 Feb 1;2(1):104-113. doi: 10.1016/j.jacasi.2021.10.011. eCollection 2022 Feb.

Authors

Affiliations

¹ Division of Rehabilitation Medicine, Kobe University Hospital, Kobe, Japan.
² Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.
³ Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
⁴ Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
⁵ Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

Abstract

Background: Postextubation dysphagia (PED) is a serious postoperative complication following cardiovascular surgery that can lead to a worse prognosis. On the other hand, frailty is a prognostic factor in patients who undergo cardiac surgery.

Objectives: This study investigated the effect of frailty status on PED and impact of PED on postoperative complications.

Methods: This single-center retrospective cohort study included 644 consecutive patients who underwent elective cardiovascular surgery between May 1, 2014, and December 31, 2020; they were assigned to the PED or non-PED group based on postoperative swallowing status, and postoperative complications were investigated. Frailty status and physical functions, including walking speed, grip strength, Short Physical Performance Battery, and 6-minute walking distance, were preoperatively assessed; the frailty-status cutoff for predicting PED was determined from the receiver-operating characteristic curve.

Results: In this study cohort (mean age 67.7 years), the overall PED prevalence was 14.8%; preoperative frailty had a significantly higher prevalence in the PED group (50.0%) than in the non-PED group (20.3%; P < 0.001). PED correlated with a higher incidence of postoperative pneumonia and prolonged intensive care unit or hospital stay (P < 0.05 for all). After adjustment for confounders, multiple regression analysis revealed that preoperative frailty was independently associated with PED (P < 0.001).

Conclusions: PED occurred commonly after cardiovascular surgery and increased the risk of postoperative complications. Preoperative frailty was independently associated with PED. The 6-minute walking distance was the most powerful predictor of PED. Evaluation of preoperative frailty status is important for risk stratification and prevention of postoperative morbidity in patients undergoing surgery.

Keywords: 6MWD, 6-minute walking distance; PED, post-extubation dysphagia; SPPB, Short Physical Performance Battery; cardiac surgery; dysphagia; frailty; postoperative pneumonia.