title: A Targeted Swallow Screen for the Detection of Postoperative Dysphagia.
abstract: Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.
authors.affiliation: Division of Cardiac Surgery and †Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Gee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lancaster
authors.forename: Jospeh
authors.initials: J
authors.lastname: Meltzer
authors.forename: Abie H
authors.initials: AH
authors.lastname: Mendelsohn
authors.forename: Peyman
authors.initials: P
authors.lastname: Benharash
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends