title: A Novel Risk Score to Predict Dysphagia After Cardiac Surgery Procedures.
abstract: BACKGROUND
  Although the exact cause of dysphagia after cardiac operations is unknown, timely diagnosis is critical to avoid a devastating aspiration event. Accordingly, we sought to generate the risk of dysphagia in cardiac surgery (RODICS) score to identify patients at risk for its development after heart surgery.
  
  
  METHODS
  All adult heart surgery patients at our institution between January 2011 and March 2012 were analyzed. A videofluoroscopic swallow study stratified patients into two groups based on the presence or absence of dysphagia. Covariates (p < 0.20) were included in a multivariable model to determine the strongest independent predictors of postoperative dysphagia. Based on the relative odds ratios of significant variables, the RODICS score was generated. Risk cohorts were then created based on easily applicable, whole-integer score cutoffs.
  
  
  RESULTS
  During the study period, 115 of 1,314 patients (8.8%) undergoing heart surgery were diagnosed with clinically significant dysphagia. The 38-point RODICS score comprises seven patient-specific characteristics and perioperative factors. The low risk (less than 4), intermediate risk (5 to 9), and high risk (more than 9) cohorts had postoperative dysphagia rates of 3.0%, 6.8%, and 21.6%, respectively (p < 0.001). The intermediate-risk cohort (odds ratio 2.3, 95% confidence interval: 1.33 to 4.27, p = 0.01) and high-risk cohort (odds ratio 8.9, 95% confidence interval: 5.22 to 15.32, p < 0.001) were at significantly higher risk of dysphagia developing. The RODICS score demonstrated excellent discriminatory ability (area under the curve 0.75).
  
  
  CONCLUSIONS
  The incidence and impact of dysphagia after open cardiac operations is significant. This novel scoring system could lead to prompt identification of patients at high risk for postoperative dysphagia and potentially minimize the complications of aspiration.
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: J Trent
authors.initials: JT
authors.lastname: Magruder
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Rika
authors.initials: R
authors.lastname: Ohkuma
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Dungan
authors.affiliation: Speech-Language Pathology, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hayes
authors.affiliation: Speech-Language Pathology, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Vose
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Megan
authors.initials: M
authors.lastname: Orlando
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Sussman
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Duke E
authors.initials: DE
authors.lastname: Cameron
authors.affiliation: Division of Cardiac Surgery, Physical Medicine and Rehabilitation, The Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: gwhitman@jhmi.edu.
authors.forename: Glenn J R
authors.initials: GJ
authors.lastname: Whitman
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003680:Deglutition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment