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Background Chronic pulmonary disease (CPD) has been previously correlated with delayed swallowing reflexes and discoordination between respiration and swallowing. This study aims to determine the influence of preoperative CPD on postoperative dysphagia rates in patients undergoing cervical spine surgery.
Methods A prospectively collected multi-institutional quality registry was retrospectively reviewed. Both preoperative and postoperative (1, 3, and 12 months) Eating Assessment Tool-10 (EAT-10) dysphagia scores were collected to assess dysphagia in patients. A score ≥ 3 indicated dysphagia. Patients were grouped by whether they reported CPD preoperatively, which was self-identified during enrollment. Mixed-effects logistic regression models were generated to control for the confounding effects of additional factors and determine whether CPD independently correlated with postoperative dysphagia.
Results Of 2,001 patients, 218 (10.9%) had preoperative CPD. Patients with CPD were significantly more likely to report dysphagia at baseline (25% vs. 14%, p< 0.001), 3 months (39% vs. 28%, p=0.003), and 12 months (43% vs. 24%, p< 0.001) but not at 1 month (65% vs. 55%, p=0.059). Within the subset of patients without baseline dysphagia (n=1,701), CPD patients (n=163) had significantly higher prevalence of developing dysphagia at 3 months (31% vs. 23% p = 0.040) and 12 months (29% vs. 19%) postoperatively but not at 1 month (54% vs. 52% p = 0.7). These patients also experienced a significantly worse trajectory in dysphagia severity between baseline and 12 months (2.587±4.364 vs. 1.759±4.322, p=0.006) despite similar baseline EAT-10 scores (0.110±0.401 vs. 0.118±0.413, p=0.8). Controlling for baseline dysphagia as a fixed effect, multivariable analyses demonstrated preoperative CPD independently predicted dysphagia at 12 months postoperatively (OR: 1.70, 95% Cl: 1.09–2.66, p=0.020) but not at 1 month (OR=0.92, 95% CI: 0.58–1.47, p=0.7) or 3 months (OR=1.26, 95% CI: 0.86–1.86, p=0.2).
Conclusion
CPD independently predicted dysphagia at 12 months after controlling for confounding, and this susceptibility was further reflected by the worse 12-month severity trajectory observed in CPD patients. Future research into the relationship between CPD and esophageal function throughout postoperative recovery would be valuable to better guide patient decision-making to undergo elective cervical spine surgery.
