Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Medicine, Division of Gastroenterology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA.
Nutr Clin Pract. 2023 Feb;38(1):157-166. doi: 10.1002/ncp.10889. Epub 2022 Jul 5.
Preoperative dysphagia screening is rare. The purpose of this study was to assess the prevalence and potential risk factors of preoperative dysphagia risk in adults preparing for surgery.
The Eating Assessment Tool (EAT-10), Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and Sarcopenia Screening Tool (SARC-F) were self-administered in adults preparing for surgery to identify dysphagia, malnutrition, and sarcopenia risk, respectively. Other variables collected include clinical demographics, fall risk, and surgical history associated with increased dysphagia risk. Descriptive summary statistics, univariate analysis, and logistic regression were performed as appropriate.
The median age was 69 years and preoperative dysphagia risk was 9.6%. Among 357 patients completing both EAT-10 and PG-SGA SF or SARC-F, 7.3% had preoperative dysphagia and malnutrition risk and 7.2% had preoperative dysphagia and sarcopenia risk. Preoperative dysphagia risk was 2.7 times greater in those with prior surgical history associated with increased risk of dysphagia, 2.2 times higher in women, and almost twice as high in Black patients and patients with fall risk. Logistic regression revealed significant odds ratios (ORs) for prior surgical history associated with increased risk of dysphagia (OR, 2.95; 95% CI, 1.62-5.40) and male sex (OR, 0.52; 95% CI, 0.29-0.94), and a significant relationship between preoperative dysphagia and malnutrition risk (OR, 4.56; 95% CI, 2.02-10.28) when controlling for clinical variables.
The high prevalence of dysphagia risk alone and in combination with malnutrition and sarcopenia risk in community-dwelling adults underscores the need for standardized preoperative screening and optimization prior to surgery.
术前吞咽困难筛查较为少见。本研究旨在评估成年人术前吞咽困难风险的发生率和潜在危险因素。
术前准备手术的成年人自行使用饮食评估工具（EAT-10）、患者生成的主观整体评估简短表格（PG-SGA SF）和肌少症筛查工具（SARC-F）来识别吞咽困难、营养不良和肌少症风险。还收集了其他变量，包括临床人口统计学、跌倒风险和与吞咽困难风险增加相关的手术史。适当进行描述性汇总统计、单变量分析和逻辑回归分析。
中位年龄为 69 岁，术前吞咽困难风险为 9.6%。在完成 EAT-10 和 PG-SGA SF 或 SARC-F 的 357 名患者中，有 7.3%的患者有术前吞咽困难和营养不良风险，有 7.2%的患者有术前吞咽困难和肌少症风险。与吞咽困难风险增加相关的既往手术史患者的术前吞咽困难风险高 2.7 倍，女性患者高 2.2 倍，黑人和有跌倒风险的患者高近 2 倍。逻辑回归显示与吞咽困难风险增加相关的既往手术史的比值比（OR）显著（OR，2.95；95%置信区间，1.62-5.40）和男性性别（OR，0.52；95%置信区间，0.29-0.94），以及术前吞咽困难与营养不良风险之间存在显著相关性（OR，4.56；95%置信区间，2.02-10.28），在控制临床变量后。
社区居住的成年人中单独存在和与营养不良和肌少症风险同时存在的高吞咽困难风险发生率强调了在手术前需要进行标准化的术前筛查和优化。
