Risk Factors for Dysphagia Following a Cervical Fusion in a Trauma Population

• Published in: Curēus (Palo Alto, CA) Vol. 10; no. 10; p. e3489
• Main Authors: Cameron, Kathryn, Lawless, Michael H, Conway, Robert, Paik, Gijong, Tong, Doris, Soo, Teck M, Lopez, Peter P
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 24.10.2018; Cureus
• Subjects: Age; Coma; Comorbidity; Dysphagia; Gender; Hospitals; Injuries; Medical records; Mortality; Neurosurgery; Nursing; Ostomy; Patients; Pneumonia; Risk factors; Speech therapy; Surgery; Trauma; United States > US; Michigan; dysphagia; cervical spine injury; cervical arthrodesis
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.3489

Background Dysphagia following a cervical fusion is a known complication; however, this has not been examined in the trauma population. We sought to identify risk factors that can be optimized in this population. Methods We performed a retrospective chart review on consecutive trauma patients who underwent a cervical fusion from 2014 to 2017 at a single institution with multiple surgeons. We included patients more than 18-years-old who were admitted through the emergency department with a diagnosis of acute cervical injury and underwent a cervical fusion during the same admission. We excluded patients who remained intubated postoperatively or underwent a tracheostomy. The primary outcome was dysphagia as evaluated by a bedside swallow test on postoperative day one by the nursing staff. This was followed by a standardized assessment performed by a speech therapist on postoperative day two in some cases. Variables of interest included sex, age, mechanism of injury, surgical approach, cervical levels, and Charlson comorbidity index. Univariate analysis was also utilized. Results Sixty patients met the study criteria. Nineteen patients (31.7%) developed dysphagia postoperatively. Mechanical falls were the most common injury mechanism (80%) and most surgical procedures were performed on the subaxial cervical spine (68.3%). Comparing the dysphagia groups, there was no significant difference among the confounding variables. Patients with dysphagia had an increased length of stay (10.6 ± 6.7 vs. 7.4 ± 3.1, = 0.056) and were more likely to have had an anterior vs. posterior cervical fusion (63.2% vs. 34.1%, = 0.056). Conclusions We found no statistically significant risk factors leading to postoperative dysphagia. The objective of this pilot is to find the baseline dysphagia rate and the potential modifiable factors in this unique patient population undergoing cervical fusion procedures.