title: Routine evaluation for aspiration after thoracotomy for pulmonary resection.
abstract: BACKGROUND
  The purpose of this study was to evaluate the role of a routine protocol for evaluation of oropharyngeal aspiration after thoracotomy for pulmonary resection.
  
  
  METHODS
  Demographic, operative, and outcomes data were collected prospectively for consecutive patients undergoing thoracotomy for pulmonary resection starting in April 2005. Starting on postoperative day one, patients underwent evaluation by a licensed speech therapist before per os intake. Patients failing clinical examination were referred for radiographic evaluation. Diets were advanced on the basis of results from both clinical and radiographic evaluation. Data analysis included descriptive statistics, Student's t test, and chi2 test when appropriate.
  
  
  RESULTS
  One hundred forty patients were prospectively evaluated during this period. Thirty-two patients (22.9%) failed initial clinical swallowing evaluation and were referred for dynamic videofluoroscopic esophagram. Twenty-five patients (17.8%) had evidence of potential oropharyngeal aspiration on videofluoroscopic esophagram. Only 1 patient (0.7%) aspirated after a negative clinical evaluation. Univariate risk factor analysis revealed that patients demonstrating aspiration were older (67.7 +/- 1.6 years versus 64.4 +/- 1.1 years; p = 0.10) and had a higher incidence of head and neck malignancy (p < 0.001). Patients without radiographic aspiration had a shorter median hospital stay when compared with those who did (6 days versus 5 days).
  
  
  CONCLUSIONS
  Aspiration after thoracotomy for pulmonary resection may affect nearly 20% of patients and is likely underrepresented in the surgical literature. The institution of a protocol to evaluate risk of aspiration has characterized patients at high risk and led to an increased awareness of the potential for aspiration after thoracotomy.
authors.affiliation: Division of Cardiothoracic Surgery, University of South Florida, Tampa, Florida, USA.
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Vicki
authors.initials: V
authors.lastname: Lewis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Blazick
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Maxey
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Garrett
authors.forename: K Eric
authors.initials: KE
authors.lastname: Sommers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011015:Pneumonia, Aspiration / Q000209:etiology*; D012307:Risk Factors; D013066:Speech-Language Pathology / Q000191:economics; D013908:Thoracotomy / Q000009:adverse effects*