Ohba Tetsuro, Akaike Hiroshi, Fujita Koji, Oda Kotaro, Tanaka Nobuki, Tomokazu Matsuoka, Sakurai Daiju, Haro Hirotaka
Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan.
Department of Rehabilitation, University of Yamanashi, Yamanashi, Japan.
Spine Surg Relat Res. 2020 Aug 31;5(1):10-15. doi: 10.22603/ssrr.2020-0104. eCollection 2021.
Postoperative respiratory complications (PRC) are one of the most serious complications. Potentially life-threatening accidents can occur after an anterior cervical discectomy and fusion (ADF), such as airway obstruction and aspiration pneumonia. Despite numerous studies, preoperative predictive and preventive methodology has yet to be established. As reported in our previous study, the evaluation of preoperative dysphagia using the eating assessment tool (EAT-10) and a flexible endoscopic evaluation of swallowing (FEES) is useful for predicting the incidence and risk factors of dysphagia after ADF.
This prospective study comprised 60 consecutive patients who underwent ADF. An otolaryngologist and a speech-language-hearing therapist preoperatively and 1 week postoperatively evaluated dysphagia using EAT-10 and Hyodo-Komagane (H-K) scores during FEES. Patient demographics, comorbidities, and pre- and postoperative dysphagia were compared between patients with and without PRC.
Seven of 60 (11.6%) patients had preoperative dysphagia diagnosed using the H-K score. A significant positive correlation existed between the pre- and postoperative H-K scores. Of all 60 cases, eight (13.3%) had PRC. Among them, two required reintubation due to airway obstruction and six had aspiration pneumonia. The PRC(+) group was significantly older and more prone to diabetes and asthma. The preoperative H-K score of the PRC(+) group was significantly higher than that of the PRC(-) group. Postoperatively, but not preoperatively, EAT-10 was significantly higher in the PRC(+) group.
Preoperative dysphagia may potentially exacerbate postoperative dysphagia after ADF. A preoperative evaluation of dysphagia using the H-K score during FEES is a useful method for predicting and reducing the risk of PRC. Level of Evidence: 3.
术后呼吸并发症（PRC）是最严重的并发症之一。颈椎前路椎间盘切除融合术（ADF）后可能发生危及生命的意外情况，如气道阻塞和吸入性肺炎。尽管有大量研究，但术前预测和预防方法尚未确立。正如我们之前的研究所报道，使用进食评估工具（EAT-10）对术前吞咽困难进行评估以及采用吞咽功能的软性内镜评估（FEES）有助于预测ADF术后吞咽困难的发生率和危险因素。
这项前瞻性研究纳入了60例连续接受ADF手术的患者。一名耳鼻喉科医生和一名言语语言听力治疗师在术前以及术后1周使用EAT-10和FEES期间的Hyodo-Komagane（H-K）评分对吞咽困难进行评估。比较了有和没有PRC的患者的人口统计学特征、合并症以及术前和术后的吞咽困难情况。
60例患者中有7例（11.6%）术前使用H-K评分诊断为吞咽困难。术前和术后H-K评分之间存在显著正相关。在所有60例病例中，8例（13.3%）发生了PRC。其中，2例因气道阻塞需要重新插管，6例发生吸入性肺炎。PRC（+）组年龄显著更大，更易患糖尿病和哮喘。PRC（+）组的术前H-K评分显著高于PRC（-）组。术后，而非术前，PRC（+）组的EAT-10显著更高。
术前吞咽困难可能会加重ADF术后的吞咽困难。在FEES期间使用H-K评分对术前吞咽困难进行评估是预测和降低PRC风险的有用方法。证据级别：3级。
