Cameron Kathryn, Lawless Michael H, Conway Robert, Paik Gijong, Tong Doris, Soo Teck M, Lopez Peter P
Surgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA.
Neurosurgery, Ascension Providence Hospital, Michigan State University, College of Human Medicine, Southfield, USA.
Cureus. 2018 Oct 24;10(10):e3489. doi: 10.7759/cureus.3489.
Background Dysphagia following a cervical fusion is a known complication; however, this has not been examined in the trauma population. We sought to identify risk factors that can be optimized in this population. Methods We performed a retrospective chart review on consecutive trauma patients who underwent a cervical fusion from 2014 to 2017 at a single institution with multiple surgeons. We included patients more than 18-years-old who were admitted through the emergency department with a diagnosis of acute cervical injury and underwent a cervical fusion during the same admission. We excluded patients who remained intubated postoperatively or underwent a tracheostomy. The primary outcome was dysphagia as evaluated by a bedside swallow test on postoperative day one by the nursing staff. This was followed by a standardized assessment performed by a speech therapist on postoperative day two in some cases. Variables of interest included sex, age, mechanism of injury, surgical approach, cervical levels, and Charlson comorbidity index. Univariate analysis was also utilized. Results Sixty patients met the study criteria. Nineteen patients (31.7%) developed dysphagia postoperatively. Mechanical falls were the most common injury mechanism (80%) and most surgical procedures were performed on the subaxial cervical spine (68.3%). Comparing the dysphagia groups, there was no significant difference among the confounding variables. Patients with dysphagia had an increased length of stay (10.6 ± 6.7 vs. 7.4 ± 3.1, = 0.056) and were more likely to have had an anterior vs. posterior cervical fusion (63.2% vs. 34.1%, = 0.056). Conclusions We found no statistically significant risk factors leading to postoperative dysphagia. The objective of this pilot is to find the baseline dysphagia rate and the potential modifiable factors in this unique patient population undergoing cervical fusion procedures.
颈椎融合术后吞咽困难是一种已知的并发症；然而，尚未在创伤患者群体中对此进行研究。我们试图确定在该群体中可以优化的风险因素。方法：我们对2014年至2017年在一家有多位外科医生的单一机构接受颈椎融合术的连续创伤患者进行了回顾性病历审查。我们纳入了年龄超过18岁、通过急诊科入院且诊断为急性颈椎损伤并在同一住院期间接受颈椎融合术的患者。我们排除了术后仍插管或接受气管切开术的患者。主要结局是术后第一天由护理人员通过床边吞咽试验评估的吞咽困难情况。在某些情况下，术后第二天由言语治疗师进行标准化评估。感兴趣的变量包括性别、年龄、损伤机制、手术入路、颈椎节段和查尔森合并症指数。还进行了单因素分析。结果：60例患者符合研究标准。19例患者（31.7%）术后出现吞咽困难。机械性跌倒为最常见的损伤机制（80%），大多数手术操作在颈椎下颈椎进行（68.3%）。比较吞咽困难组，混杂变量之间无显著差异。吞咽困难患者的住院时间延长（10.6±6.7天对7.4±3.1天，P=0.056），并且更有可能接受前路而非后路颈椎融合术（63.2%对34.1%，P=0.056）。结论：我们未发现导致术后吞咽困难的具有统计学意义的风险因素。本试点研究的目的是在接受颈椎融合手术的这一独特患者群体中找到吞咽困难的基线发生率和潜在的可改变因素。
