title: Clinical predictors of aspiration after esophagectomy in esophageal cancer patients.
abstract: OBJECTIVE
  The purposes of this study are to assess the usefulness of bedside swallowing tests and identify the clinical risk factors for subglottic aspiration after esophagectomy in esophageal cancer patients.
  
  
  METHODS
  The study included patients who underwent esophagectomy for esophageal cancer between January and August 2013. Videofluoroscopic swallowing study (VFSS) was carried out 7 to 10 days post-surgery, and clinical bedside swallowing tests were conducted to determine the risk factors for subglottic aspiration.
  
  
  RESULTS
  A total of 118 patients were evaluated, 38 of whom (32.2%) showed evidence of subglottic aspiration on VFSS. The clinical bedside swallowing test yielded positive results in 26 of the 38 patients with subglottic aspiration (sensitivity 68.4%). Prolonged operation time and vocal cord paralysis were risk factors predicting aspiration in multiple logistic regression analysis (odds ratio (OR), 0.651 per hour; P = 0.017 and OR, 9.1; P < 0.001). When operation times were divided into two groups, greater than or equal to 6 h (≥6 h) and less than 6 h (<6 h), the OR of operation time ≥6 h to aspiration was increased to 3.22 (P = 0.007).
  
  
  CONCLUSIONS
  We found that the clinical bedside swallowing test had a sensitivity of 68.4%, which, without VFSS, was insufficient to detect subglottic aspiration. Operation time greater than or equal to 6 h and vocal cord paralysis were risk factors for subglottic aspiration. Therefore, VFSS should be recommended in esophageal cancer patients who have operation time greater than or equal to 6 h or have vocal cord paralysis after esophagectomy.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Seung Yeol
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Cheon
authors.affiliation: Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Sang Jun
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
authors.affiliation: Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea. hwanglee@skku.edu.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Hwang
mesh_terms: D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D019095:Point-of-Care Systems; D012307:Risk Factors
keywords: Clinical bedside swallowing tests; Dysphagia; Esophageal cancer; Esophagectomy; Videofluoroscopic swallowing study