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  • Risk Factors and Clinical Outcomes of Dysphagia After Anterior Cervical Surgery in Patients With Degenerative Cervical Myelopathy: Results from the AOSpine International and North America Studies

    Final Number:
    312

    Authors:
    Lindsay Tetreault Bsc; Narihito Nagoshi MD, PhD; Hiroaki Nakashima MD; Paul M. Arnold MD; Giuseppe Barbagallo MD; Branko Kopjar MD; Michael G. Fehlings MD PhD FRCS(C) FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The objective of this study is to determine the incidence and risk factors of postoperative dysphagia and to evaluate short- and long-term clinical outcomes in patients with this complication.

    Methods: Four hundred and seventy patients undergoing an anterior or a 2-stage surgery were enrolled in the prospective AOSpine CSM-North America or International study at 26 global sites. Logistic regression analyses were conducted to determine important clinical and surgical predictors of dysphagia. Preoperatively and at each follow-up, patients were evaluated using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and the SF-36. A mixed model analytic approach was used to evaluate differences in outcomes at 6- and 24-months between patients with and without dysphagia, while controlling for relevant baseline characteristics and surgical factors.

    Results: The overall incidence of dysphagia was 6.17%. Univariately, the major risk factors for perioperative dysphagia were a higher co-morbidity score (OR:1.289,p=0.0019), the presence of cardiovascular (OR:2.584,p=0.0163) and endocrine (OR:4.234,p=0.0003) disorders, a 2-stage surgery (OR (ref=1-stage):6.506,p=0.0003) and a greater number of decompressed levels (OR:1.816,p=0.0022). Based on multivariate analysis, patients were at an increased risk of perioperative dysphagia if they had diabetes (OR (ref=absence):3.686,p=0.0014), a greater number of decompressed segments (OR: 1.522,p=0.0498), and a 2-stage surgery (OR (ref=1-stage):3.423,p=0.037). Clinical improvements, as evaluated by the Nurick and mJOA, were comparable between patients with and without dysphagia at both short- and long-term follow-up. In contrast, patients with dysphagia had significantly worse scores on the NDI at 6-months postoperative than patients without dysphagia; however, at 24-months postoperative, there were no difference between groups.

    Conclusions: The most important predictors of dysphagia are diabetes, a greater number of decompressed levels and a 2-stage surgery. Patients with postoperative dysphagia have reduced disability and quality of life improvements in the short-term but not in the long-term.

    Patient Care: By identifying high risk patients, clinicians can take appropriate preoperative and postoperative precautions to avoid dysphagia.

    Learning Objectives: To determine the risk factors of dysphagia and discuss whether this complication affect surgical outcomes.

    References:

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