Purpose: Dysphagia is a possible complication after anterior cervical spine surgery (ACSS). Studies indicate specific risk factors for dysphagia and that in a subset of patients, dysphagia post-ACSS is not transient. This study aimed to evaluate the impact of dysphagia after ACSS, investigate potential risk factors for its occurrence, assess modalities utilized to diagnose dysphagia, examine pertinent referral patterns, and explore the utilization of speech-language pathology services post-ACSS.
Method: This retrospective study was performed using data from a tertiary academic medical center from patients post-ACSS over a 6-month period. Patient sociodemographic, surgical, and clinical information and diagnosis of dysphagia were recorded. Evaluation of risk factors for post-ACSS dysphagia, diagnostic modality utilized, complications, and referral patterns were assessed.
Results: Among 106 patients post-ACSS, 17 (16%) were diagnosed with dysphagia. Preoperative dysphagia was the only significant risk factor for post-ACSS dysphagia (OR = 8.705). Patients with postoperative dysphagia had significantly higher rates of complications, including gastrostomy tube placement (p < .001), respiratory infection (p < .001), 30-day readmission rates (p < .001), and mortality (p = .004). Symptomatic patients were referred for evaluation 100% as inpatients but only 50% of the time as outpatients. Furthermore, swallowing was evaluated with an objective assessment in only 31.4% of patients with symptomatic dysphagia.
Conclusions: In our post-ACSS cohort, we identified a relatively low incidence (16%) of patients diagnosed with dysphagia when compared with the literature. We also identified gaps between scientific knowledge and clinical practice, which was evidenced by the lack of pre- and postoperative screening for dysphagia, the relatively low use of instrumental swallowing exams, and the low referral rate for outpatient clinical swallowing assessments post-ACSS. We hope that the findings from this work prompt others to evaluate clinical practice patterns related to patients undergoing ACSS and inform focused quality improvement projects.