title: A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia.
abstract: OBJECTIVE
  This study assesses the effect of using a comprehensive swallowing evaluation before starting oral feedings on aspiration detection and pneumonia occurrence after esophagectomy.
  
  
  METHODS
  The records of all patients undergoing esophagectomy between January 1996 and June 2009 were reviewed. Multivariable logistic regression analysis assessed the effect of preoperative and operative variables on the incidence of aspiration and pneumonia. Separate analyses were performed on patients before (early era, 1996-2002) and after (later era, 2003-2009) a rigorous swallowing evaluation was used routinely before starting oral feedings.
  
  
  RESULTS
  During the study period, 799 patients (379 from the early era and 420 from the later era) underwent esophagectomy; 30-day mortality was 3.5% (28 patients). Cervical anastomoses were performed in 76% of patients in the later era compared with 40% of patients in the early era. Overall, 96 (12%) patients had evidence of aspiration postoperatively, and the pneumonia incidence was 14% (113 patients). Age (odds ratio, 1.05 per year; P < .0001) and later era (odds ratio, 1.90; P = .0001) predicted aspiration in all patients in a multivariable model. In the early era, cervical anastomosis and aspiration independently predicted pneumonia. With a comprehensive swallowing evaluation in the later era, the detected incidence of aspiration increased (16% vs 7%, P < .0001), whereas the incidence of pneumonia decreased (11% vs 18%, P = .004) compared with the early era, such that neither anastomotic location nor aspiration predicted pneumonia in the later era.
  
  
  CONCLUSIONS
  Esophagectomy is often associated with occult aspiration. A comprehensive swallowing evaluation for aspiration before initiating oral feedings significantly decreases the occurrence of pneumonia.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. berry037@mc.duke.edu
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.forename: B Zane
authors.initials: BZ
authors.lastname: Atkins
authors.forename: Betty C
authors.initials: BC
authors.lastname: Tong
authors.forename: David H
authors.initials: DH
authors.lastname: Harpole
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
mesh_terms: D003680:Deglutition Disorders / Q000150:complications* / Q000175:diagnosis*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors