title: Finding the red flags: Swallowing difficulties after cardiac surgery in patients with prolonged intubation.
abstract: OBJECTIVE
  This retrospective audit set out to identify referral rates, swallowing characteristics, and risk factors for dysphagia and silent aspiration in at-risk patients after cardiac surgery. Dysphagia and silent aspiration are associated with poorer outcomes post cardiac surgery.
  
  
  METHODS
  One hundred ninety patients who survived cardiac surgery and received more than 48 hours of intubation were included. Preoperative, perioperative, and postoperative information was collected.
  
  
  RESULTS
  Forty-one patients (22%) were referred to speech-language pathology for a swallowing assessment. Twenty-four of these patients (13%) underwent instrumental swallowing assessment, and silent aspiration was observed in 17 (70% of patients diagnosed as having dysphagia via instrumental assessment). Multilogistic analysis revealed previous stroke (P < .05), postoperative stroke (P < .001), and tracheostomy (P < .001) independently associated with dysphagia. The odds ratio for being diagnosed as having pneumonia, if a patient was diagnosed as having dysphagia, was 3.3.
  
  
  CONCLUSIONS
  Patients identified with dysphagia after cardiac surgery had a high incidence of silent aspiration and increased risk of pneumonia. However, referral rates were low in this at-risk patient group. Early identification and ongoing assessment and appropriate management of dysphagic patients by a speech-language pathologist are strongly recommended.
authors.affiliation: The University of Auckland, Auckland, New Zealand. Electronic address: edal913@aucklanduni.ac.nz.
authors.forename: Emma
authors.initials: E
authors.lastname: Daly
authors.affiliation: The University of Auckland, Auckland, New Zealand. Electronic address: a.miles@auckland.ac.nz.
authors.forename: Anna
authors.initials: A
authors.lastname: Miles
authors.affiliation: Auckland District Health Board, Auckland, New Zealand. Electronic address: SamanthaSc@adhb.govt.nz.
authors.forename: Samantha
authors.initials: S
authors.lastname: Scott
authors.affiliation: Auckland District Health Board, Auckland, New Zealand. Electronic address: MGillham@adhb.govt.nz.
authors.forename: Michael
authors.initials: M
authors.lastname: Gillham
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D054869:Clinical Audit; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007440:Intubation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011014:Pneumonia / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014139:Tracheostomy / Q000009:adverse effects
keywords: Cardiac surgery; Dysphagia; Silent aspiration; Speech-language pathology; Tracheostomy